Individual
DR. LYNETTE ROCHELLE WILSON-PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4112 E PONCE DE LEON AVE, CLARKSTON, GA 30021-1817
(404) 296-7133
(404) 501-9744
Mailing address
5268 SANDY SHORES CT, LITHONIA, GA 30038-3957
(404) 405-6863
(404) 501-9744
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
038132
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000681106B
—
GA
05
—
000681106C
—
GA
Enumeration date
04/13/2006
Last updated
09/19/2011
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