Provider Demographics
NPI:1073041166
Name:WILSON'S WELLNESS CLINICAL CARE, LLC
Entity type:Organization
Organization Name:WILSON'S WELLNESS CLINICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-981-3936
Mailing Address - Street 1:1310 ROCKBRIDGE RD STE F
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3163
Mailing Address - Country:US
Mailing Address - Phone:770-864-5538
Mailing Address - Fax:404-393-4038
Practice Address - Street 1:1310 ROCKBRIDGE RD STE F
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3163
Practice Address - Country:US
Practice Address - Phone:770-864-5538
Practice Address - Fax:404-393-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care