Provider Demographics
NPI:1376073577
Name:WILSON, RACHEL JAFFE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:JAFFE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RAINTREE BND
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2228
Mailing Address - Country:US
Mailing Address - Phone:770-365-0487
Mailing Address - Fax:
Practice Address - Street 1:609 GARAMOND PL
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2606
Practice Address - Country:US
Practice Address - Phone:770-365-0487
Practice Address - Fax:770-365-0487
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA401171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist