Healthcare Provider Details

I. General information

NPI: 1568371136
Provider Name (Legal Business Name): GRACIE WILBER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 RED BUD RD NE
CALHOUN GA
30701-6010
US

IV. Provider business mailing address

307 MANITOWOC DR
WESTMINSTER SC
29693-6529
US

V. Phone/Fax

Practice location:
  • Phone: 706-602-7800
  • Fax:
Mailing address:
  • Phone: 678-834-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: