Individual
DR. ERIC WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5440 HILLANDALE DR, KAISER PERMANENTE PANOLA MEDICAL CENTER, LITHONIA, GA 30058-4865
(770) 322-2777
(706) 549-5981
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 364-7070
(706) 549-5981
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
030694
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00381917C
—
GA
05
—
00381917D
—
GA
01
—
080184143
MEDICARE RAILROAD
GA
01
—
4491297
AETNA
GA
01
—
481143
BCBS
GA
Enumeration date
08/19/2006
Last updated
01/10/2022
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