Individual
ERICA R WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDCCCSLP
Contact information
Practice address
2395 WALL ST SE, SUITE 190, CONYERS, GA 30013-6703
(404) 202-8490
(770) 679-9344
Mailing address
3141 BRIGHTON PASS, CONYERS, GA 30094-3357
(404) 202-8490
(770) 679-9344
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006266
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435026966A
—
GA
Enumeration date
06/10/2005
Last updated
12/11/2013
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