Active NPI
Steven Lamar Wilson, D.M.D.
- General Practice Dentistry
- Martinez, GA
National Provider Identifier
1811957376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8466
- Practice address
- 4059 Columbia Rd
Martinez, GA 30907-2221 - Phone
- (706) 863-9445
- Fax
- (706) 863-7452
- NPI assigned
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8466 | GA | Primary |
Addresses
Primary practice location
4059 Columbia Rd
Martinez, GA 30907-2221
Mailing address
4059 Columbia Rd
Martinez, GA 30907-2221
Phone (706) 863-9445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00064424A | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8466 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583107200000",
"number": "1811957376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4059 COLUMBIA RD",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309072221",
"telephone_number": "706-863-9445",
"fax_number": "706-863-7452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4059 COLUMBIA RD",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309072221",
"telephone_number": "706-863-9445",
"fax_number": "706-863-7452"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STEVEN",
"middle_name": "LAMAR",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2020-03-02",
"certification_date": "2020-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "8466",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00064424A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Martinez, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.