Provider Demographics
NPI:1417193434
Name:WILSON, CATHERINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:ELTING
Other - Last Name:DRAGON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3300 OLD MILL COURT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-727-3028
Mailing Address - Fax:404-727-2203
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:AVON COMPREHENSIVE BREAST CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-778-1230
Practice Address - Fax:404-778-4255
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001060363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical