Individual
BRYANT D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
4000 SMITHTOWN RD STE 200, SUWANEE, GA 30024-6560
(470) 632-4990
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-84880
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-19-84880
RBT CERTIFICATE
GA
Enumeration date
04/25/2019
Last updated
04/25/2019
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