Provider Demographics
NPI:1295348936
Name:BATTLE, WILSON CULLEN
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:CULLEN
Last Name:BATTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODRUFF CIRCLE,EMORY UNIVERSITY SCHOOL OF MEDICINE
Mailing Address - Street 2:SUITE P375
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-727-5655
Mailing Address - Fax:
Practice Address - Street 1:100 WOODRUFF CIRCLE,EMORY UNIVERSITY SCHOOL OF MEDICINE
Practice Address - Street 2:SUITE P375
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-727-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-07-29
Deactivation Date:2022-06-30
Deactivation Code:
Reactivation Date:2022-07-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician