Provider Demographics
NPI:1265530414
Name:WILSON, NATHANIEL ANDREW III (PSYD)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:ANDREW
Last Name:WILSON
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7730
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30357-0730
Mailing Address - Country:US
Mailing Address - Phone:404-550-9981
Mailing Address - Fax:404-475-4880
Practice Address - Street 1:1201 W PEACHTREE ST NW STE 2300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3453
Practice Address - Country:US
Practice Address - Phone:404-550-9981
Practice Address - Fax:404-719-4242
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY002857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA624392123AMedicaid