Individual
ALICIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-5036
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-5036
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
17805
GA
Other
Enumeration date
05/16/2025
Last updated
05/16/2025
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