Individual
MRS. JOANN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1766 OLD LELAND RD, GREENVILLE, MS 38703
(662) 537-4976
(662) 537-4977
Mailing address
1766 OLD LELAND RD, GREENVILLE, MS 38703
(662) 537-4976
(662) 537-4977
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
801597391
MS
172A00000X
Driver
—
—
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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