Provider Demographics
NPI:1255198156
Name:WILSON, KAMI' AQUIRA
Entity type:Individual
Prefix:
First Name:KAMI'
Middle Name:AQUIRA
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 CHURCH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2103
Mailing Address - Country:US
Mailing Address - Phone:610-573-6933
Mailing Address - Fax:
Practice Address - Street 1:7537 WOODBINE PL
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-7172
Practice Address - Country:US
Practice Address - Phone:610-573-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician