Individual
SHIRLEY DIANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 STARLING ST, SUITE 606, BRUNSWICK, GA 31520-4219
(912) 466-5636
(912) 466-5639
Mailing address
2500 STARLING ST, SUITE 606, BRUNSWICK, GA 31520-4219
(912) 466-5636
(912) 466-5639
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
034742
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00516139D
—
GA
Enumeration date
06/23/2006
Last updated
08/29/2014
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