Provider Demographics
NPI:1669279360
Name:WILSON, BARBARA (MS)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:WILSON
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 OLD JEFFERSON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1463
Mailing Address - Country:US
Mailing Address - Phone:706-400-4262
Mailing Address - Fax:706-418-5929
Practice Address - Street 1:3320 OLD JEFFERSON RD STE 400
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1463
Practice Address - Country:US
Practice Address - Phone:706-400-4262
Practice Address - Fax:706-418-5929
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch