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General NPI Number Information
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NPI Number | 1548588825
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Entity Type | Individual
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Provider Name | JEFFREY A WILSON-REESE PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 05/11/2010
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Provider Practice Location Address
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Address Line | 4600 FULTON MILL RD CENTRAL S.P. MENTAL HEALTH DEPT.
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City | MACON
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State | GA
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Zip | 31208-2500
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Country | US
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Telephone | 478-472-2943
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Fax |
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Provider Business Mailing Address
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Address Line | 299 JULE INGRAM RD NE
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-7962
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Country | US
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Telephone |
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY001959
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License Number State | GA
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