Individual
DR. MARTIN RALPH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
110 EVANS MILL DR STE 309, DALLAS, GA 30157-1623
(678) 594-3579
(678) 653-7540
Mailing address
2842 BENT CREEK DR NW, KENNESAW, GA 30152-2623
(404) 966-8672
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR009825
GA
111NS0005X
Sports Physician Chiropractor
CHIR009825
GA
Other
Enumeration date
02/09/2017
Last updated
03/25/2019
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