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Individual

EMMA LEONOR WHEELER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1136 BLUE JAY RD, RINCON, GA 31326-4927
(912) 658-2486
Mailing address
1136 BLUE JAY RD, RINCON, GA 31326-4927
(912) 658-2486

Taxonomy

Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
058844834
GA
2255A2300X
Athletic Trainer
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
058844834
DRIVER'S LICESNE
GA
Enumeration date
10/28/2020
Last updated
01/19/2022
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