Provider Demographics
NPI:1518383959
Name:WILSON, DANA M (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 ROCKBRIDGE ROAD, SW
Mailing Address - Street 2:SUITE F
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087
Mailing Address - Country:US
Mailing Address - Phone:770-864-5538
Mailing Address - Fax:404-393-4038
Practice Address - Street 1:1310 ROCKBRIDGE ROAD, SW
Practice Address - Street 2:SUITE F
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30087
Practice Address - Country:US
Practice Address - Phone:770-864-5538
Practice Address - Fax:404-393-4038
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily