Individual
ZACHARY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
171 PRICE RD, FAYETTEVILLE, GA 30215-2016
(770) 460-9795
Mailing address
PO BOX 38, FAYETTEVILLE, GA 30214-0038
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
124058
GA
Other
Enumeration date
06/19/2023
Last updated
06/19/2023
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