Individual
DR. LEROY AUGUSTUS WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
315 BOULEVARD NE, SUITE 316, ATLANTA, GA 30312-1200
(404) 659-1234
(404) 659-0640
Mailing address
315 BOULEVARD NE, SUITE 316, ATLANTA, GA 30312-1200
(404) 659-1234
(404) 659-0640
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
012594
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000024351D
—
GA
Enumeration date
06/28/2006
Last updated
03/11/2013
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