Individual
DR. STEPHANIE E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
243 CURTISS RD STE 100, BARKSDALE AFB, LA 71110-2425
(318) 456-6555
Mailing address
7110 EDEN CT, RIVERDALE, GA 30296-2159
(770) 761-0672
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
055716
GA
2083A0100X
Aerospace Medicine Physician
Primary
055716
GA
Other
Enumeration date
09/29/2006
Last updated
03/31/2023
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