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Individual

MARVEL PAMELA WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
225 JOHNSON RD APT 38B, FOREST PARK, GA 30297-2892
(404) 437-8289
Mailing address
225 JOHNSON RD APT 38B, FOREST PARK, GA 30297-2892
(404) 437-8289

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
347C00000X
GA

Other

Enumeration date
04/07/2014
Last updated
04/07/2014
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