Provider Demographics
NPI:1144398140
Name:WILSON, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:425 N COBB ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2683
Mailing Address - Country:US
Mailing Address - Phone:478-454-1034
Mailing Address - Fax:478-454-1114
Practice Address - Street 1:425 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2634
Practice Address - Country:US
Practice Address - Phone:478-454-1034
Practice Address - Fax:478-454-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0547022084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA932114OtherBCBS OF GEORGIA
GA357412106AMedicaid
GA054702OtherGEORGIA LICENSE
GAP00292646OtherRAILROAD MEDICARE
GAP00292646OtherRAILROAD MEDICARE
GA13BDFBHMedicare PIN
GA932114OtherBCBS OF GEORGIA