Active NPI
Mary Wilson
- Professional Counselor
- Summerville, GA
National Provider Identifier
1003471632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 003040
- Practice address
- 11578 Highway 27
Summerville, GA 30747-5873 - Phone
- (706) 857-5441
- Fax
- (706) 857-7607
- NPI assigned
- May 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 003040 | GA | Primary |
Addresses
Primary practice location
11578 Highway 27
Summerville, GA 30747-5873
Mailing address
PO Box 308
Cartersville, GA 30120-0308
Phone (770) 880-2185
Other practice location 1
501 Mize St
LA Fayette, GA 30728-3346
Phone (706) 638-5591
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1003471632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 308",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301200308",
"telephone_number": "770-880-2185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11578 HIGHWAY 27",
"city": "SUMMERVILLE",
"state": "GA",
"postal_code": "307475873",
"telephone_number": "706-857-5441",
"fax_number": "706-857-7607"
}
],
"practiceLocations": [
{
"address_1": "501 Mize St",
"address_purpose": "LOCATION",
"city": "LA Fayette",
"state": "GA",
"postal_code": "307283346",
"country_code": "US",
"telephone_number": "706-638-5591",
"fax_number": "706-639-2055",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-08",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "003040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.