| Wilson's Wellness Clinical Care, Llc | |
|
14b Professional Ct Sw Rome GA 30165-2832 | |
| (404) 981-3936 | |
| (404) 393-4038 |
| Full Name | Wilson's Wellness Clinical Care, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14b Professional Ct Sw, Rome, Georgia |
| Authorized Official Name and Position | Dana Wilson (OWNER/MANAGER) |
| Authorized Official Contact | 4049813936 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilson's Wellness Clinical Care, Llc 7435 Crescent Bend Cv Stone Mountain GA 30087-6207 Ph: (140) 439-62754 | Wilson's Wellness Clinical Care, Llc 14b Professional Ct Sw Rome GA 30165-2832 Ph: (404) 981-3936 |
| NPI Number | 1073041166 |
|---|---|
| Provider Enumeration Date | 06/01/2017 |
| Last Update Date | 06/01/2017 |
| Medicare PECOS PAC ID | 0941576136 |
|---|---|
| Medicare Enrollment ID | O20171016000915 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073041166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Dana Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518383959 PECOS PAC ID: 1456621291 Enrollment ID: I20171016001719 |
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