Jacqueline Holley Wilson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

4305 S Lee St Ste 500
Buford, GA 30518-5785

Phone

(678) 602-9229

Fax

(770) 995-1959

NPI assigned

May 13, 2019

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 16, 2024 through Jan 16, 2028

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Insight Counseling and Coaching

  • Professional Counselor
  • Buford, GA
  • NPI 1184030116
  NPD
• Team Mobile Health Care

  • Land Ambulance
  • Atlanta, GA
  • NPI 1003788852
  NPD (past)
• Young Minds Psychiatry, LC

  • Psychiatry Physician
  • Atlanta, GA
  • NPI 1629330154
  NPD (past)

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1740846039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3644 BUTTERCUP CT",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305191983",
            "telephone_number": "678-602-9229",
            "fax_number": "770-995-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 S LEE ST STE 500",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305185785",
            "telephone_number": "678-602-9229",
            "fax_number": "770-995-1959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACQUELINE",
        "middle_name": "HOLLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-13",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Willis
• Abigail Teiko Wilson, PHARMD
• Annissa Annette Wilson, FNP-C
• Blessy Wilson, RBT
• Heather Leigh Wilson, CMA
• Robyn Wilson, BCBA
• Elizabeth Wood
• Kristin E Woodruff, NP, RN
• Jasmine Lanette Woods, RN
• Lorraine Wrage, M.ED., LPC, CST

• Clinical Social Worker in Buford, GA
• Providers in Buford, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.