Provider Demographics
NPI:1356468441
Name:WILSON, SANDRA BAIRD (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:BAIRD
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MARLENE
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2005 PRINCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-208-9700
Mailing Address - Fax:706-208-0878
Practice Address - Street 1:2005 PRINCE AVENUE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-208-9700
Practice Address - Fax:706-208-0878
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01551363LF0000X
GARN096987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11722746Medicaid
NMCNP01551OtherNEW MEXICO NP CERTIFICATION NUMBER
CO180464OtherLICENSE NUMBER
NM11722746Medicaid
NM265195YS5YMedicare PIN