Individual
LISA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
950 INDIAN TRAIL LILBURN RD NW STE 5D, LILBURN, GA 30047-6870
(470) 545-2131
Mailing address
950 INDIAN TRAIL LILBURN RD NW STE 5D, LILBURN, GA 30047-6870
(470) 545-2131
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
58124
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58124
REGISTRY
GA
Enumeration date
01/31/2018
Last updated
02/13/2024
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