Individual
KENNETH L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4398 ATLANTA HWY, LOGANVILLE, GA 30052-7314
(678) 639-0129
(678) 639-1547
Mailing address
4398 ATLANTA HWY, LOGANVILLE, GA 30052-7314
(678) 639-0129
(678) 639-1547
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10952
GA
Other
Enumeration date
09/24/2011
Last updated
09/24/2011
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