Organization
MINWIL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVEL PAMELA WILSON (OWNER/MEMBER)
(404) 437-8289
Entity
Organization
Contact information
Practice address
225 JOHNSON RD APT 38B, FOREST PARK, GA 30297-2892
(404) 437-8289
Mailing address
225 JOHNSON RD APT 38B, FOREST PARK, GA 30297-2892
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
04/18/2014
Last updated
04/18/2014
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