Wilson, Lisa A

Wilson, Lisa A is an individual health care provider with primary practice located at 1061 Harmon Ave Dept General , Fort Stewart GA 31314-5641. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as her primary health care specialty. Wilson, Lisa A can be contacted via phone (912) 435-5595.

Contact Information

Primary practice address
1061 Harmon Ave Dept General Fort Stewart GA 31314-5641
Phone: (912) 435-5595
Fax: (912) 435-6305
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 003755 Georgia

Profile Details

NPI number 1558363275
LBN Legal business name Wilson, Lisa A
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2005
Last updated Aug 22nd, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558363275 NPPES
Georgia MEDICAID 753648566A

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