Individual
MR. JAMAR TRAVIS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3868 VILLAGE CROSSING LN, ELLENWOOD, GA 30294-5724
(706) 589-6652
Mailing address
3868 VILLAGE CROSSING LN, ELLENWOOD, GA 30294-5724
(706) 589-6652
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
002523
GA
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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