Provider Demographics
NPI:1801252671
Name:WILSON, CHRISTY (RN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 WALTON WAY STE 6300
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-5109
Mailing Address - Country:US
Mailing Address - Phone:706-724-5611
Mailing Address - Fax:706-724-5435
Practice Address - Street 1:1348 WALTON WAY STE 6300
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5109
Practice Address - Country:US
Practice Address - Phone:706-724-5611
Practice Address - Fax:706-724-5435
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209045163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery