Active NPI
Bryant W Wilson, M.D.
- Surgery Physician
- Atlanta, GA
National Provider Identifier
1275573388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 029824
- Practice address
- 95 Collier Rd NW
Suite 6015
Atlanta, GA 30309-1796 - Phone
- (404) 351-5959
- Fax
- (404) 351-8526
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 029824 | GA | Primary |
Addresses
Primary practice location
95 Collier Rd NW
Suite 6015
Atlanta, GA 30309-1796
Mailing address
95 Collier Rd NW
Suite 6015
Atlanta, GA 30309-1796
Phone (404) 351-5959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00441361B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029824 | GA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292198400000",
"number": "1275573388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 COLLIER RD NW",
"address_2": "SUITE 6015",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091796",
"telephone_number": "404-351-5959",
"fax_number": "404-351-8526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "95 COLLIER RD NW",
"address_2": "SUITE 6015",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091796",
"telephone_number": "404-351-5959",
"fax_number": "404-351-8526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BRYANT",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2010-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "GA",
"license": "029824",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00441361B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.