Individual
SHAWAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1661 WATER LILY WAY, LAWRENCEVILLE, GA 30045-2354
(716) 559-4474
Mailing address
1661 WATER LILY WAY, LAWRENCEVILLE, GA 30045-2354
(716) 559-4474
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
GA
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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