Provider Demographics
NPI:1770098287
Name:WILSON, JAMES L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:WILSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 BOULDER PARK DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-4509
Mailing Address - Country:US
Mailing Address - Phone:404-941-7255
Mailing Address - Fax:
Practice Address - Street 1:3350 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1039
Practice Address - Country:US
Practice Address - Phone:404-946-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16427183500000X
IN26022984A183500000X
GARPH027714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist