Basic Information
| Provider Information | |||||||||
| NPI: | 1346237187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3155 N POINT PKWY | ||||||||
| Address2: | ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100 | ||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706459181 | ||||||||
| FaxNumber: | 7706458455 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 WINDY HILL RD SE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300678665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785740943 | ||||||||
| FaxNumber: | 6785740943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 12/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 53633 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 177784027C | 05 | GA | MEDICAID | 177784027D | 05 | GA | MEDICAID | 177784027E | 05 | GA | MEDICAID | 177784027B | 05 | GA | MEDICAID | 177784027G | 05 | GA | MEDICAID | 177784027A | 05 | GA | MEDICAID | 177784027F | 05 | GA | MEDICAID | 177784027H | 05 | GA | MEDICAID |