Individual
KWASI WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606-2797
(706) 475-5076
Mailing address
11306 E 27TH ST, YUMA, AZ 85367-8946
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48528
AZ
207R00000X
Internal Medicine Physician
Primary
83751
GA
208M00000X
Hospitalist Physician
48528
AZ
Other
Enumeration date
08/23/2013
Last updated
12/18/2019
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