Provider Demographics
NPI:1346258977
Name:WILSON, JOSEPH S JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:755 MOUNT VERNON HWY
Mailing Address - Street 2:530
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4274
Mailing Address - Country:US
Mailing Address - Phone:404-252-7970
Mailing Address - Fax:404-250-0553
Practice Address - Street 1:755 MOUNT VERNON HWY
Practice Address - Street 2:530
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4274
Practice Address - Country:US
Practice Address - Phone:404-252-7970
Practice Address - Fax:404-250-0553
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2009-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA20626207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000324959 B, FMedicaid
GAD42148Medicare UPIN
GA000324959 B, FMedicaid