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Organization
PBS
Active
Organization
PBS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHANTII WILSON (ASSISTANT)
(478) 421-4938
Entity
Organization
Contact information
Practice address
500 NORTHSIDE XING STE A, MACON, GA 31210-2377
(478) 216-2876
Mailing address
500 NORTHSIDE XING STE A, MACON, GA 31210-2377
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/27/2026
Last updated
04/27/2026
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