Jacqueline D Wilson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1512 Issued in GA

Practice address

3760 Lavista Rd
Suite 102
Tucker, GA 30084-5615

Phone

(404) 248-0415

Fax

(404) 248-0422

NPI assigned

Dec 28, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508922246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 PARKLAND CT SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300824732",
            "telephone_number": "404-248-0415",
            "fax_number": "404-248-0422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 LAVISTA RD",
            "address_2": "SUITE 102",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845615",
            "telephone_number": "404-248-0415",
            "fax_number": "404-248-0422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "1512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00546653D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura J Williams, LCSW
• Monica J.R. Williams, M.D.
• Tameica Williams, LCSW
• Tarrah B. Williams, PHARM.D.
• Tatiana Williams
• Jerry Dewayne Wilson, PA-C
• Kristin Nicole Wilson, DMD
• Patricia Wilson
• Rosemarie Wilson, CASE MANAGER
• Samantha Elizabeth Wilson, MASSAGE THERAPIST

• Physical Therapist in Tucker, GA
• Providers in Tucker, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.