Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | POD001494 | GA |
NPI | 1033606967 |
---|---|
Provider Name | Dr. Amy G. Wilson |
First Address | Stockbridge, GA 30281-7350 |
Second Address | Stockbridge, GA 30281-7350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 31/01/2022 |