Individual
JOHN WILSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4059 COLUMBIA RD, MARTINEZ, GA 30907-2221
(706) 863-9445
(706) 863-7452
Mailing address
442 AUMOND RD, AUGUSTA, GA 30909-3561
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122429
GA
Other
Enumeration date
07/07/2021
Last updated
04/05/2023
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