Individual
DR. NICHELLE J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD, CCC-A
Contact information
Practice address
3400 CHAPEL HILL RD, DOUGLASVILLE, GA 30135-1739
(678) 741-5310
Mailing address
PO BOX 176, DOUGLASVILLE, GA 30133-0176
(678) 741-5310
(866) 278-2672
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AUD004014
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08122016222502
NPPES HEALTHCARE FACILITY
GA
Enumeration date
08/01/2016
Last updated
12/25/2016
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