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Individual

HALEY B. WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(770) 535-3611
(770) 535-7092
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 533-4786

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3272
GA
363AM0700X
Medical Physician Assistant
Primary
003272
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100000357A
GA
05
100000358A
GA
05
100000359B
GA
05
100000359C
GA
01
10032996
AMERIGROUP
GA
01
303673
WELLCARE
GA
01
303676
WELLCARE
GA
01
303679
WELLCARE
GA
01
303686
WELLCARE
GA
Enumeration date
02/06/2006
Last updated
08/17/2023
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