Healthcare Provider Details

I. General information

NPI: 1285567354
Provider Name (Legal Business Name): AIDRIENNE WILSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 RUSTY PLOW LN
PERRY GA
31069-9870
US

IV. Provider business mailing address

245 RUSTY PLOW LN
PERRY GA
31069-9870
US

V. Phone/Fax

Practice location:
  • Phone: 229-733-8755
  • Fax:
Mailing address:
  • Phone: 229-733-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: