Individual
DOMINIQUE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1017 FAYETTEVILLE RD SE # B, ATLANTA, GA 30316-2932
(404) 486-9034
Mailing address
1017 FAYETTEVILLE RD SE # B, ATLANTA, GA 30316-2932
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/16/2018
Last updated
07/16/2018
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