Individual
TINIKI WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1061 HARMON AVE, FT. STEWART, GA 31314-5641
(912) 315-5417
Mailing address
1061 HARMON AVE, FT. STEWART, GA 31314-5641
(912) 315-5417
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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