Individual
MRS. LISA WILSON- JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3854 PAPER BIRCH LN, LITHONIA, GA 30038-3342
(678) 480-5054
(888) 884-6471
Mailing address
3854 PAPER BIRCH LN, LITHONIA, GA 30038-3342
(678) 480-5054
(888) 884-6471
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
332U00000X
Home Delivered Meals
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
09/22/2015
Last updated
06/11/2019
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