Healthcare Provider Details

I. General information

NPI: 1316489073
Provider Name (Legal Business Name): DEBORAH LYNNE WILSON MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 TOWNE PARK DR STE 400
RINCON GA
31326
US

IV. Provider business mailing address

11 GATEWAY BLVD S
SAVANNAH GA
31419-9782
US

V. Phone/Fax

Practice location:
  • Phone: 912-210-9558
  • Fax: 912-826-0125
Mailing address:
  • Phone: 912-210-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number14882
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: