Individual
JANICE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4055 BRUSHYMILL CT, LOGANVILLE, GA 30052
(770) 334-7396
Mailing address
4055 BRUSHYMILL CT, LOGANVILLE, GA 30052
(770) 334-7396
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
NT017440
GA
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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