Individual
JOHNNY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
925 CALHOUN AVE, YAZOO CITY, MS 39194-3229
(662) 746-7770
(662) 746-4185
Mailing address
925 CALHOUN AVE, YAZOO CITY, MS 39194-3229
(662) 746-7770
(662) 746-4185
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1629
MS
Other
Enumeration date
10/29/2009
Last updated
10/29/2009
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