NPIMap

Organization Active NPI

Wilson Family Chiropractic

  • Chiropractor
  • Dunwoody, GA
National Provider Identifier
1417286410
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHIR008587 Issued in GA
Legal business name
WILSON FAMILY CHIROPRACTIC
Practice address
2498 Jett Ferry Rd Ste 100
Dunwoody, GA 30338-3062
Phone
(678) 205-1573
Fax
(678) 205-1574
NPI assigned
Dec 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jacob Wesley Wilson, D.C.NPI 1730418476
Title
Ceo
Phone
(678) 205-1573

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X CHIR008587 GA Primary
Pediatric ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111NP0017X CHIR008587 GA
Radiology ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111NR0200X CHIR008587 GA

Addresses

Primary practice location

2498 Jett Ferry Rd Ste 100
Dunwoody, GA 30338-3062

Mailing address

2498 Jett Ferry Rd Ste 100
Dunwoody, GA 30338-3062
Phone (678) 205-1573

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100319000358 GA Part B Supplier - Clinic/Group Practice 5890820567 Receives reassigned benefits from 3 practitioners
Practice locations: Dunwoody, GA

National Provider Directory

National Provider Directory

Locations

2494 Jett Ferry Rd
Ste 103
Dunwoody, GA 30338
Phone (404) 805-5961

2498 Jett Ferry Rd
Ste 100
Dunwoody, GA 30338
Phone (404) 805-5961

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1417286410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2498 JETT FERRY RD STE 100",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303383062",
            "telephone_number": "678-205-1573",
            "fax_number": "678-205-1574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2498 JETT FERRY RD STE 100",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303383062",
            "telephone_number": "678-205-1573",
            "fax_number": "678-205-1574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON FAMILY CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-22",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-205-1573",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR008587",
            "primary": true
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "GA",
            "license": "CHIR008587",
            "primary": false
        },
        {
            "code": "111NR0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor, Radiology",
            "state": "GA",
            "license": "CHIR008587",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dunwoody, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.