Organization
MICHAEL E WILSON OD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL E WILSON OD (OPTOMETRIST OWNER)
(770) 461-2144
Entity
Organization
Contact information
Practice address
320 N JEFF DAVIS DR, SUITE A, FAYETTEVILLE, GA 30214-1669
(770) 461-2144
(770) 461-5792
Mailing address
320 N JEFF DAVIS DRIVE, SUITE A, FAYETTEVILLE, GA 30214-1669
(770) 461-2144
(770) 461-5792
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
GA800
GA
Other
Enumeration date
01/29/2008
Last updated
08/03/2010
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