Provider Demographics
NPI:1578722591
Name:WILKINS, JOSEPH GARY
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GARY
Last Name:WILKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W GORDON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3425
Mailing Address - Country:US
Mailing Address - Phone:706-646-6329
Mailing Address - Fax:706-646-6039
Practice Address - Street 1:605 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3425
Practice Address - Country:US
Practice Address - Phone:706-646-6329
Practice Address - Fax:706-646-6039
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional