Provider Demographics
NPI:1922365444
Name:WILBURN, JOSHUA J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:J
Last Name:WILBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8787
Mailing Address - Fax:770-838-8922
Practice Address - Street 1:25 W LYON ST
Practice Address - Street 2:
Practice Address - City:TALLAPOOSA
Practice Address - State:GA
Practice Address - Zip Code:30176-1288
Practice Address - Country:US
Practice Address - Phone:770-824-2800
Practice Address - Fax:770-824-2810
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA077594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid