Provider Demographics
NPI:1235170614
Name:ROBERT J. WILSON, M.D., P.C.
Entity Type:Organization
Organization Name:ROBERT J. WILSON, M.D., P.C.
Other - Org Name:HOPE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-882-8018
Mailing Address - Street 1:70 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6835
Mailing Address - Country:US
Mailing Address - Phone:912-882-8018
Mailing Address - Fax:912-510-6035
Practice Address - Street 1:70 LINDSEY LN
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6835
Practice Address - Country:US
Practice Address - Phone:912-882-8018
Practice Address - Fax:912-510-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7720Medicare ID - Type UnspecifiedMEDICARE GROUP #