Individual
BRENT A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 PEACHTREE ST NE, APT 1303, ATLANTA, GA 30308-1245
(410) 533-2000
(480) 287-8015
Mailing address
800 PEACHTREE ST NE, APT 1303, ATLANTA, GA 30308-1245
(410) 533-2000
(480) 287-8015
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
059350
GA
2084P0800X
Psychiatry Physician
Primary
DR.0053468
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60886358
—
CO
Enumeration date
10/24/2007
Last updated
06/19/2014
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