Individual
CHARLENE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, LD
Contact information
Practice address
1325 SATELLITE BLVD NW STE 103, SUWANEE, GA 30024-4697
(770) 231-9264
Mailing address
4553 FAIRECROFT TER, SUWANEE, GA 30024-4066
(770) 231-9264
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD005433
GA
Other
Enumeration date
11/19/2019
Last updated
02/24/2023
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