Provider Demographics
NPI:1568529139
Name:WILKINSON SERVICE CENTER
Entity Type:Organization
Organization Name:WILKINSON SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-628-2777
Mailing Address - Street 1:113 SOLOMON ST
Mailing Address - Street 2:P. O. BOX 69
Mailing Address - City:GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:31031-3323
Mailing Address - Country:US
Mailing Address - Phone:478-628-2777
Mailing Address - Fax:478-628-2780
Practice Address - Street 1:113 SOLOMON ST
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:GA
Practice Address - Zip Code:31031-0069
Practice Address - Country:US
Practice Address - Phone:478-628-2777
Practice Address - Fax:478-628-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services