Individual
DONNAH ANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CHT
Contact information
Practice address
790 CHURCH ST NE, SUITE 390, MARIETTA, GA 30060-7282
(404) 355-0069
(404) 355-6825
Mailing address
5490 E EMERALD CT, ACWORTH, GA 30102-2055
(770) 974-5431
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT LICENSE 001570
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001570
GA OT LICENSE
GA
05
—
00885717B
—
GA
Enumeration date
07/10/2006
Last updated
07/08/2007
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