Individual
MICHELLE LERMOND WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1000 TOWNE CENTER BLVD BLDG 1200, POOLER, GA 31322-4129
(912) 748-2280
(912) 748-4988
Mailing address
1000 TOWNE CENTER BLVD BLDG 1200, POOLER, GA 31322-4129
(912) 748-2280
(912) 748-4988
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39698
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52576493
BCBS
GA
01
—
P00422522
RAILROAD MEDICARE PIN
GA
Enumeration date
07/20/2006
Last updated
02/01/2024
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