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General NPI Number Information
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NPI Number | 1154528685
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Entity Type | Individual
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Provider Name | ELIZABETH ROBIN WILSON C.N.M.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 916 S BROAD ST
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City | THOMASVILLE
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State | GA
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Zip | 31792-6113
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Country | US
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Telephone | 229-226-8800
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Fax | 229-226-1660
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Provider Business Mailing Address
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Address Line | 360 COLLEGE ST
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City | BLAKELY
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State | GA
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Zip | 39823-2554
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Country | US
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Telephone | 229-723-2660
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Fax | 229-723-5969
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | RN123110
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License Number State | GA
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