Provider Demographics
NPI:1851285654
Name:LOGAN WILSON, EBONY (PHLEBOTOMIST, INS)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:LOGAN WILSON
Suffix:
Gender:F
Credentials:PHLEBOTOMIST, INS
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:LOGAN WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:THE STICK ZONE
Mailing Address - Street 1:3515 SUMMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2628
Mailing Address - Country:US
Mailing Address - Phone:334-614-2132
Mailing Address - Fax:
Practice Address - Street 1:223 PARADISE DRIVE
Practice Address - Street 2:
Practice Address - City:SMITH STATION
Practice Address - State:AL
Practice Address - Zip Code:36877
Practice Address - Country:US
Practice Address - Phone:334-219-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANAPTP5057396062246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy