Individual
MS. SAMANTHA ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
2185 NORTHLAKE PKWY STE 100, TUCKER, GA 30084-4100
(770) 493-6360
(770) 493-6350
Mailing address
2185 NORTHLAKE PKWY STE 100, TUCKER, GA 30084-4100
(770) 493-6360
(770) 493-6350
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT004816
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT004816
STATE LICENSE NUMBER
GA
Enumeration date
05/07/2013
Last updated
05/07/2013
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