Provider Demographics
NPI:1558661868
Name:WILSON, ROSEMARIE (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3469 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5888
Mailing Address - Country:US
Mailing Address - Phone:770-723-7700
Mailing Address - Fax:770-723-7388
Practice Address - Street 1:3469 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5888
Practice Address - Country:US
Practice Address - Phone:770-723-7700
Practice Address - Fax:770-723-7388
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00378300104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator