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Individual

ELIZABETH L. WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PNP

Contact information

Practice address
215 12TH ST W, TIFTON, GA 31794-3923
(229) 396-5335
(229) 396-5330
Mailing address
215 12TH ST W, TIFTON, GA 31794-3923
(229) 396-5335
(229) 396-5330

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN191733
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RN191733
GA MEDICAL LICENSE
GA
Enumeration date
03/16/2012
Last updated
04/29/2026
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