Provider Demographics
NPI:1740515972
Name:WILSON, CHRISTIE EVE (MS, ATC)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:EVE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SAINT LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5476
Mailing Address - Country:US
Mailing Address - Phone:678-778-4111
Mailing Address - Fax:404-425-1524
Practice Address - Street 1:1300 SAINT LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5476
Practice Address - Country:US
Practice Address - Phone:678-778-4111
Practice Address - Fax:404-425-1524
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist