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General NPI Number Information
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NPI Number | 1639848930
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Entity Type | Individual
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Provider Name | NICOLE JAMES WILSON D.C.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 1736 BRANDEMERE DRIVE
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City | AUSTELL
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State | GA
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Zip | 30168
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Country | US
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Telephone | 404-919-9037
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Fax |
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Provider Business Mailing Address
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Address Line | 1736 BRANDEMERE DR
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City | AUSTELL
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State | GA
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Zip | 30168-5341
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Country | US
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Telephone | 281-543-5015
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO09405
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License Number State | GA
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