Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 030695 | GA |
NPI | 1063587061 |
---|---|
Provider Name | William Hayes Wilson |
First Address | Atlanta, GA 30309-1476 |
Second Address | Atlanta, GA 30309-1476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00419735C | (05) | GA |
01205851077 | ME # (01) | |
F42842 | (02) |