Provider Demographics
NPI:1770698029
Name:WILSON, PETER WYMAN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:WYMAN
Last Name:WILSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1256 BRIARCLIFF RD NE
Mailing Address - Street 2:EPICORE--SUITE 1 NORTH
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2636
Mailing Address - Country:US
Mailing Address - Phone:404-728-6854
Mailing Address - Fax:866-434-1997
Practice Address - Street 1:1670 CLAIRMONT WAY NE
Practice Address - Street 2:ATLANTA VA MEDICAL CENTER--DEPT OF MEDICINE/CARDIOLOGY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1614
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-7794
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
SC26554207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism