Individual
DEWANNA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1421 MOUNT WATER CT, LAWRENCEVILLE, GA 30043-6234
(404) 645-2960
Mailing address
1421 MOUNT WATER CT, LAWRENCEVILLE, GA 30043-6234
(404) 645-2960
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN200756
GA
Other
Enumeration date
01/12/2017
Last updated
05/19/2021
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