Individual
EBONY LOGAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHLEBOTOMIST, INS
Contact information
Practice address
223 PARADISE DRIVE, SMITH STATION, AL 36877
(334) 219-0308
Mailing address
3515 SUMMERVILLE RD, PHENIX CITY, AL 36867-2628
(334) 614-2132
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
NAPTP5057396062
GA
Other
Enumeration date
06/05/2025
Last updated
06/05/2025
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