Individual
SUSAN B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
134 E FAIRMOUNT AVE, CEDARTOWN, GA 30125-2706
(770) 748-5212
(770) 748-2944
Mailing address
420 E 2ND AVE, SUITE 103, ROME, GA 30161-3224
(706) 509-3278
(706) 509-4608
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
045387
GA
Other
Enumeration date
08/03/2006
Last updated
07/09/2007
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