Individual
LEVI WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1575 N EAST EXPY NE, BROOKHAVEN, GA 30329-2401
(543) 740-4758
Mailing address
390 APPLE RIDGE 2, DAWSONVILLE, GA 30534-5140
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT002885
GA
Other
Enumeration date
06/25/2020
Last updated
06/25/2020
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