Provider Demographics
NPI:1437817525
Name:LINDA A. WILSON PH.D., P.C.
Entity Type:Organization
Organization Name:LINDA A. WILSON PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-580-1600
Mailing Address - Street 1:681 LAYFIELD BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-4110
Mailing Address - Country:US
Mailing Address - Phone:706-580-1600
Mailing Address - Fax:706-243-1346
Practice Address - Street 1:681 LAYFIELD BRANCH RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:GA
Practice Address - Zip Code:31811-4110
Practice Address - Country:US
Practice Address - Phone:706-580-1600
Practice Address - Fax:706-243-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0031482448Medicaid