MEDICARE: CHRISTINE 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	221700000X	Art Therapist

General Provider Information

NPI Number	:	1932085370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE WILSON

Provider Business Mailing Address
First Line	:	6575 AMBERGLADES LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-2801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 EXECUTIVE PARK DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2251
Country	:	US
Telephone Number	:	770-726-9589
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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Directions to “ CHRISTINE WILSON ” Practice Location

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