Provider Demographics
NPI:1336118108
Name:WILSON, W. STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:W.
Middle Name:STEVEN
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CARL VINSON PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5817
Mailing Address - Country:US
Mailing Address - Phone:478-322-3800
Mailing Address - Fax:478-322-0031
Practice Address - Street 1:129 CARL VINSON PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5817
Practice Address - Country:US
Practice Address - Phone:478-322-3800
Practice Address - Fax:478-322-0031
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000385525BMedicaid
GAD92424Medicare UPIN
GA08BBQQGMedicare PIN