Individual
ALICE ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1405 FRANKLIN RD SE, MARIETTA, GA 30067-8705
(770) 951-5400
(770) 951-5408
Mailing address
1405 FRANKLIN RD SE, MARIETTA, GA 30067-8705
(770) 951-5400
(770) 951-5408
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
029823
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000842575E
—
GA
Enumeration date
07/26/2006
Last updated
09/02/2011
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