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General NPI Number Information
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NPI Number | 1801374426
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Entity Type | Individual
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Provider Name | JESSICA ALLY WILSON ATKINS ATC, LAT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 2227 US HIGHWAY 41 N
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City | TIFTON
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State | GA
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Zip | 31794-2749
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Country | US
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Telephone | 229-353-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 2227 US HIGHWAY 41 NORTH
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City | TIFTON
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State | GA
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Zip | 31794-1563
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Country | US
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Telephone | 404-998-6216
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT002824
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT013769
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License Number State | GA
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