Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | LDO001761 | GA |
N | 156FC0801X | Contact Lens Fitter | LDO001761 | GA |
Y | 156FX1800X | Optician | LDO001761 | GA |
NPI | 1578034393 |
---|---|
Provider Name | Mrs. Cheryl Dawn Wilkins Gillespie |
First Address | Thomaston, GA 30286-3127 |
Second Address | Thomaston, GA 30286-3622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |