Provider Demographics
NPI:1881143188
Name:WILSON, DOROTHY L (RN)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 FIELDING LN SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-2045
Mailing Address - Country:US
Mailing Address - Phone:404-433-4846
Mailing Address - Fax:404-696-8280
Practice Address - Street 1:448 FIELDING LN SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-2045
Practice Address - Country:US
Practice Address - Phone:404-433-4846
Practice Address - Fax:404-696-8280
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN099490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse