Individual
MITCHELL JAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
707 OLD DALTON ELLIJAY RD, CHATSWORTH, GA 30705-2029
(706) 517-2030
(706) 517-2076
Mailing address
P.O. BOX 12938, C/O CLINIC MANAGEMENT, CALHOUN, GA 30703
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
061188
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
248099221D
—
GA
Enumeration date
06/07/2006
Last updated
12/19/2018
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