Individual
BEVERLY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
700 DALRYMPLE RD, 203, ATLANTA, GA 30328-1414
(404) 940-0784
Mailing address
PO BOX 291, ELLENWOOD, GA 30294-0291
(404) 940-0784
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT006291
GA
Other
Enumeration date
03/03/2011
Last updated
04/14/2015
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