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General NPI Number Information
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NPI Number | 1558969188
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Entity Type | Individual
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Provider Name | CHRISTIANE WILSON
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 7380 SPOUT SPRINGS RD
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-7541
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Country | US
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Telephone | 770-965-5644
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Fax | 770-965-5632
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Provider Business Mailing Address
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Address Line | 4232 LANSMOORE XING
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City | SUWANEE
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State | GA
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Zip | 30024-6969
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Country | US
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Telephone | 404-542-7141
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 021678
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License Number State | GA
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