Provider Demographics
NPI:1013000777
Name:WILSON, BARBARA MITCHELL (CRNFA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MITCHELL
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1415
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0025
Mailing Address - Country:US
Mailing Address - Phone:770-476-7047
Mailing Address - Fax:770-476-5845
Practice Address - Street 1:3500 MCCLURE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3131
Practice Address - Country:US
Practice Address - Phone:770-476-7047
Practice Address - Fax:770-476-5845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR069686163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant