Individual
CRYSTAL M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
270 DOLLY MADISON CT, MACON, GA 31220-2605
(478) 957-7029
Mailing address
270 DOLLY MADISON CT, MACON, GA 31220-2605
(478) 957-7029
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN054323
GA
Other
Enumeration date
10/19/2010
Last updated
10/19/2010
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