Martin Ralph Wilson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR009825 Issued in GA

Practice address

110 Evans Mill Dr Ste 309
Dallas, GA 30157-1623

Phone

(678) 594-3579

Fax

(678) 653-7540

NPI assigned

Feb 9, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1609314723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2842 BENT CREEK DR NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301522623",
            "telephone_number": "404-966-8672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 EVANS MILL DR STE 309",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301571623",
            "telephone_number": "678-594-3579",
            "fax_number": "678-653-7540"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2842 Bent Creek Dr NW",
            "address_purpose": "LOCATION",
            "city": "Kennesaw",
            "state": "GA",
            "postal_code": "301522623",
            "country_code": "US",
            "telephone_number": "404-966-8672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARTIN",
        "middle_name": "RALPH",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-09",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "GA",
            "license": "CHIR009825",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR009825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzette Delicia Williams, LPC
• Tyleesha Williams
• Linda Suzanne Williamson-Kersey, LMSW, CSW, CADC LL,
• Dorella Wilson-Woods
• Jordan Wilson
• Chandler Winner, PT
• Amanueal Wodajo
• Bridgette Denise Wokal, SA-C
• Saba Woldegebriel, RPH
• Mark Stephen Wolfe, PH.D.

• Chiropractor in Dallas, GA
• Providers in Dallas, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; 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.