Provider Demographics
NPI:1023061751
Name:WILSON, DANELLE PHELPS (MD)
Entity type:Individual
Prefix:MRS
First Name:DANELLE
Middle Name:PHELPS
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANELLE
Other - Middle Name:
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3180 NORTH POINT PKWY, SUITE 410
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-664-0088
Mailing Address - Fax:770-664-8228
Practice Address - Street 1:3180 NORTH POINT PKWY, SUITE 410
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-664-0088
Practice Address - Fax:770-664-8228
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054365208000000X
GA54365208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics