Provider Demographics
NPI:1164892618
Name:WILSON, CARRIE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 TREE LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:678-775-1501
Mailing Address - Fax:678-775-3585
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 110
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:678-775-1501
Practice Address - Fax:678-775-3585
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251844363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics