Provider Demographics
NPI:1003093600
Name:WILSON, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:WILSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:755 MT VERNON HWY
Mailing Address - Street 2:SUITE 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 MT VERNON HWY
Practice Address - Street 2:SUITE 530
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-252-7970
Practice Address - Fax:404-250-0553
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2012-09-14
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Provider Licenses
StateLicense IDTaxonomies
GA054294207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease