Individual
JESSICA A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
1376 GRAY HWY, MACON, GA 31211-1952
(478) 743-6006
(478) 743-6008
Mailing address
152 THE MASTERS CV, MACON, GA 31211-6004
(478) 746-3911
(478) 746-9865
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO002136
GA
Other
Enumeration date
07/30/2008
Last updated
07/15/2010
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