Levi William Wilson, ATC
Specialist/Technologist, Athletic Trainer in Brookhaven, GA. Individual provider (NPI-1).
NPI number1164049136
StatusActive
Last updated in NPPESJun 25, 2020
Details
- NPI
- 1164049136
- Entity type
- Individual (NPI-1)
- Name
- Levi William Wilson
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 25, 2020
- Certification date
- Jun 25, 2020
- Last updated
- Jun 25, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT002885 | GA | Yes |
Practice location
1575 N East Expy NeBrookhaven, GA 30329-2401
Phone 543-740-4758
Mailing address
390 Apple Ridge 2Dawsonville, GA 30534-5140
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