Provider Demographics
NPI:1356049373
Name:WILSON, VICTORIA RENEE
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:RENEE
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 1:3455 PEACHTREE RD NE FL 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3254
Mailing Address - Country:US
Mailing Address - Phone:833-725-7842
Mailing Address - Fax:
Practice Address - Street 1:3455 PEACHTREE RD NE FL 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-3254
Practice Address - Country:US
Practice Address - Phone:833-725-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy