Individual
KATHERINE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
76 HIGHLAND PAVILION CT, SUITE185, HIRAM, GA 30141-3169
(770) 384-0844
Mailing address
PO BOX 518, JONESBORO, GA 30237-0518
(770) 631-8277
(770) 631-9403
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
008431
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008431
STATE LISC NUMBER
GA
Enumeration date
11/03/2006
Last updated
07/08/2007
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