Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 071200 | GA |
NPI | 1205896933 |
---|---|
Provider Name | William Wilcox |
First Address | Decatur, GA 30033-5307 |
Second Address | Decatur, GA 30033-5307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 23/09/2019 |