Individual
MS. SUZETTE KAREN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMA,PCT,LMT
Contact information
Practice address
4172 SHILOH RIDGE TRL NW, KENNESAW, GA 30144-2160
(770) 865-9886
Mailing address
4172 SHILOH RIDGE TRL NW, KENNESAW, GA 30144-2160
(770) 865-9886
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT005239
GA
Other
Enumeration date
03/19/2010
Last updated
03/19/2010
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