Individual
CANDICE NEWTON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3708 NORTHSIDE DR, MACON, GA 31210-2404
(478) 745-4206
(478) 832-6506
Mailing address
3708 NORTHSIDE DR, MACON, GA 31210-2404
(478) 745-4206
(478) 254-5463
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT007137
GA
2251X0800X
Orthopedic Physical Therapist
Primary
PT007137
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300022345A
—
GA
Enumeration date
01/30/2018
Last updated
02/27/2026
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