Individual
RAQUEL SHELLY SOLIVAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IDMT
Contact information
Practice address
23 MEDICAL GROUP/SGPF 3278 MITCHELL BLVD BLD 900, MOODY AFB, GA 31699-8273
(229) 257-4685
(229) 257-3242
Mailing address
23 MEDICAL GROUP/SGPF 3278 MITCHELL BLVD BLDG 900, MOODY AFB, GA 31699-0001
(229) 257-4685
(229) 257-3242
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
06/23/2010
Last updated
11/08/2023
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