Most Relevant Information
Provider Data
| NPI Number: | 1003471632 |
| Provider Name: | MARY WILSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 003040 |
Most Important Dates
| Enumeration Date: | 05/08/2019 |
| Last Updated: | 05/08/2019 |
Provider Practice Location
11578 HIGHWAY 27
SUMMERVILLE
GA
307475873
Practice Location Phone/Fax
| Phone: | 7068575441 |
| Fax: | 7068577607 |
Provider Mailing Location
PO BOX 308
CARTERSVILLE
GA
301200308
Provider Mailing Phone/Fax
| Phone: | 7708802185 |
| Fax: |