Provider Information for 1518162726
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Mr. FREDDIE THOMAS WILSON LCSW
Sex: Male
NPI: 1518162726
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1518162726 | ||||||||
| Enumeration Date | 2007-06-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 5254 THE SAVOY COLLEGE PARK, GA 30349 United States Phone: 404-853-2832 | Fax: | ||||||||
| Primary Practice Address | 1105 W. PEACHTREE ST., N.E., ATLANTA, GA 30309 United States Phone: 404-853-2832 | Fax: | ||||||||
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