Individual
DEMETIRUS LEGAIL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
73 MALLARD HL, RINGGOLD, GA 30736-4964
(423) 503-4507
Mailing address
3584 BENNETT RD, EAST RIDGE, TN 37412-1167
(423) 635-8738
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
066777
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
474763392
CITY OF CHATTANOOGA
TN
Enumeration date
09/28/2018
Last updated
10/01/2024
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