MEDICARE: TANESHA WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT015679	GA

General Provider Information

NPI Number	:	1154289601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANESHA WILSON

Provider Business Mailing Address
First Line	:	1817 TRADITION WAY
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-3842
Country	:	US
Telephone Number	:	706-330-4856
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 NEILL DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7127
Country	:	US
Telephone Number	:	706-330-4856
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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Directions to “ TANESHA WILSON ” Practice Location

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