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Organization
DR JOHN T WILSON PC
Active
Organization
DR JOHN T WILSON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAIGE WILSON (CFO)
(912) 262-0542
Entity
Organization
Contact information
Practice address
1515 TILLMAN AVE, BRUNSWICK, GA 31520-6933
(912) 262-0542
(912) 262-6538
Mailing address
1515 TILLMAN AVE, BRUNSWICK, GA 31520-6933
(912) 262-0542
(912) 262-6538
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
010583
GA
122300000X
Dentist
DNO12937
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000353768C
—
GA
05
—
00353768B
—
GA
05
—
774804023A
—
GA
05
—
774804023B
—
GA
01
—
9180215
DORAL
GA
01
—
9180264
DORAL
GA
Enumeration date
03/05/2007
Last updated
07/20/2011
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