Charles Omar Wilson Jr., M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

050283 Issued in GA

Practice address

175 Samaritan Way
Jasper, GA 30143

Phone

(706) 253-4673

Fax

(706) 253-4675

NPI assigned

Jun 23, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Good Samaritan Health & Wellness Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Jasper, GA
  • NPI 1407174675
  NPD (past)

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277683200000",
    "number": "1497066518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 REDFIELD WAY",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "30143",
            "telephone_number": "706-692-0812",
            "fax_number": "706-692-0812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 SAMARITAN WAY",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "30143",
            "telephone_number": "706-253-4673",
            "fax_number": "706-253-4675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHARLES",
        "middle_name": "OMAR",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-23",
        "last_updated": "2010-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "050283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kathleen West, LCSW, INC
• Amy Marie Wheeler, FNP-C
• Pamela Whitssell
• Carolyn Noreen Wilkins, BCBA
• Sara L Williams, FNP C
• Jon Alan Wise, D.C.
• Womens Specialty Center of North Georgia
• Charlotte Wood
• Claire C Wood
• Jenny Mari Wood, LPC

• All providers in Jasper, GA
• Anatomic Pathology & Clinical Pathology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.

Verify at the official NPI Registry.