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NPI Code Detail

MEDICARE: KRISTY JAY WILSON

MEDICARE: KRISTY JAY 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
1106H00000XMarriage & Family TherapistMFT000813GA

General Provider Information

NPI Number : 1467912493
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY JAY WILSON
Provider Business Mailing Address
First Line : 717 NORTH AVENUE
Second Line :
City : MACON
State : GA
Zip : 31211-1418
Country : US
Telephone Number : 478-475-4608
Fax Number : 478-476-8397
Provider Business Practice Location Address
First Line : 144 PIERCE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2860
Country : US
Telephone Number : 478-475-4608
Fax Number : 478-476-8397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2019
Last Update Date : 05/14/2026

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1013471028 — QUITMAN JOHN BRIGMOND JR. LPC
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Directions to “ KRISTY JAY WILSON ” Practice Location

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