Individual
DR. WILEY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
176 LAKEVIEW CIR, CORDELE, GA 31015-5318
(229) 322-0570
(229) 271-7504
Mailing address
176 LAKEVIEW CIR, CORDELE, GA 31015-5318
(229) 322-0570
(229) 271-7504
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036633
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
795339666A
—
GA
Enumeration date
02/01/2006
Last updated
09/04/2009
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