JERRY DEWAYNE WILSON (NPI# 1619153210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619153210 |
| Entity Type | Individual |
| Full Name | JERRY DEWAYNE WILSON |
| Credential | PA-C |
| Practice Address |
4500 Hugh Howell Rd Suite Tucker GA 30084-4723 |
| Mailing Address |
Po Box 360550 Decatur GA 30036-0550 |
| Practice Telephone | 6786324003 |
| Practice Fax Number | 6786811305 |
| Mailing Telephone | 6786324003 |
| Mailing Fax Number | 6786811305 |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2010-12-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
003052 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 308036587A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962731786 | Jerry Wilson | Counselor | Hwy 491 N. Pinon St., Red Modular Bldg, Shiprock, NM 87420-1830 | 2009-12-08 |
| 1801204870 | Jerry W Wilson | Marriage & Family Therapist | 1232 E Wardlow Rd, Long Beach, CA 90807-4833 | 2014-07-23 |
| 1023267697 | Jerry Don Wilson | Physician Assistant | 1010 S Main St, Shamrock, TX 79079-2820 | 2008-09-18 |
| 1750437158 | Jerry Clyde Wilson | Counselor | 3516 Ne Stallings Dr, Nacogdoches, TX 75965-8732 | 2007-01-26 |
| 1740385483 | Jerry Scott Wilson | Psychiatry & Neurology | 2010 Quail Hollow Cir, Franklin, TN 37067-5967 | 2006-09-14 |
| 1184736233 | Jerry M. Wilson | Pharmacist | 4801 E Linwood Blvd, Kansas City, MO 64128-2226 | 2006-08-31 |
| 1093787087 | Jerry K. Wilson | Nurse Anesthetist, Certified Registered | 320 E North Ave, Pittsburgh, PA 15212-4756 | 2006-02-03 |
| 1144206962 | Jerry Paul Wilson | Family Medicine | 6041 Telecom Dr, Milan, TN 38358-3448 | 2005-12-22 |
| Street Address |
4500 HUGH HOWELL RD SUITE |
| City | TUCKER |
| State | GA |
| Zip Code | 30084-4723 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679579643 | Steven O. Stewart | Family Medicine | 4500 Hugh Howell Rd, Ste 220, Tucker, GA 30084 | 2005-06-24 |
| 1578017703 | Julia Eze | Nurse Practitioner | 4500 Hugh Howell Rd, Suite 110, Tucker, GA 30084-4723 | 2016-08-04 |
| 1518344068 | Sunrise Medical Company LLC | Clinic/Center | 4500 Hugh Howell Rd, Suite 110, Tucker, GA 30084-4723 | 2015-05-05 |
| 1265867014 | Joo-won Kim | Dentist | 4500 Hugh Howell Rd, Suite 140, Tucker, GA 30084-4723 | 2013-09-12 |
| 1316389679 | Deirdre Bonaparte | Speech-Language Pathologist | 4500 Hugh Howell Rd, Suite 780, Tucker, GA 30084-4723 | 2013-07-26 |
| 1700226750 | Hearts and Hands Therapy Services, Inc. | Physical Therapist | 4500 Hugh Howell Rd, Suite 780, Tucker, GA 30084-4723 | 2013-07-04 |
| 1184964967 | Stewart Family Practice, PC | Family Medicine | 4500 Hugh Howell Rd, Ste 220, Tucker, GA 30084-4723 | 2013-02-15 |
| 1033497409 | Ketan G Ginoya | Dentist | 4500 Hugh Howell Rd, 140, Tucker, GA 30084-4723 | 2011-08-02 |
| 1669777157 | Accuquest Hearing Center | Clinic/Center | 4500 Hugh Howell Rd, Ste 340, Tucker, GA 30084-4723 | 2011-01-14 |
| 1518297266 | Executive Medical Associates | Internal Medicine | 4500 Hugh Howell Rd, Building 270, Suite B, Tucker, GA 30084-4723 | 2009-12-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609401355 | Excellent Medical Transport | Ambulance | 4378 Sentry Dr, Tucker, GA 30084 | 2020-03-03 |
| 1811468796 | Caleb Lee Ebbets | Physical Therapist | 1459 Montreal Road, Medical Office Building, Suite 301, Tucker, GA 30084 | 2018-12-17 |
| 1417436130 | Benjamin Han Wook Chong | Physical Therapist | 1460 Montreal Road East, Suite 300, Tucker, GA 30084 | 2018-08-13 |
| 1336659325 | Lavista Acupuncture and Herbal Medicine | Acupuncturist | 4915 Lavista Rd, Tucker, GA 30084 | 2017-10-04 |
| 1699294207 | Debrica Butler | Counselor | 1021 Oak Chase Dr., Apt C, Tucker, GA 30084 | 2017-09-14 |
| 1295264695 | Jolanta Wazgowska Hopkins | Social Worker | 4404 Idlewood Lane, Tucker, GA 30084 | 2017-06-08 |
| 1164956157 | Sage Dental Group of Georgia LLC | Dentist | 4320 Lavista Rd, Suite C119, Tucker, GA 30084 | 2017-04-17 |
| 1689107807 | Mashail Manzur | Podiatrist | 1460 Montreal Rd E, Ste 275, Tucker, GA 30084 | 2017-04-05 |
| 1053765578 | Jessica Spruyt | Speech-Language Pathologist | 3756 Lavista Rd Suite 104, Tucker, GA 30084 | 2016-04-21 |
| 1265802318 | Spine and Orthopedics of Atlanta, LLC | Clinic/Center | 1462 Montreal Rd Ste 218, Tucker, GA 30084 | 2015-10-01 |
| Find all providers in zip 30084 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497146351 | Jiyoun Leah Park | Physician Assistant | 1468 Montreal Rd, Tucker, GA 30084-6901 | 2015-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838374 | Erica Elizabeth West | Physician Assistant | 1155 Mount Vernon Hwy Ste 101, Atlanta, GA 30338-5439 | 2020-10-12 |
| 1801402888 | Meredith Gaines | Physician Assistant | 603 W 1st St Unit 1, Rome, GA 30161-3067 | 2020-09-16 |
| 1770108805 | Kelsey Lynne Greeff | Physician Assistant | 3400 Old Milton Pkwy Ste C, Alpharetta, GA 30005-3707 | 2020-06-15 |
| 1518596733 | Rebecca Faye Tsyrlin | Physician Assistant | 2655 Dallas Hwy Sw Ste 340, Marietta, GA 30064-7518 | 2020-04-08 |
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1265089759 | Alexis Chester Jones | Physician Assistant | 3000 Old Alabama Rd # 128, Johns Creek, GA 30022-5860 | 2019-08-20 |
| 1841851680 | Lauren Price Fogarty | Physician Assistant | 5445 Meridian Marks Rd Ste 430, Atlanta, GA 30342-4755 | 2019-06-24 |
| 1386208262 | Jessica A Drews | Physician Assistant | 2342 Cortez Way Ne, Brookhaven, GA 30319-3914 | 2019-04-26 |
| 1174187421 | Krisna Patel | Physician Assistant | 1805 Honey Creek Cmns Se Ste B, Conyers, GA 30013-5829 | 2019-04-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.