1568845980 NPI number — DR. DIANA E. WILSON AUDIOLOGIST

Table of content: DR. DIANA E. WILSON AUDIOLOGIST (NPI 1568845980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568845980 NPI number — DR. DIANA E. WILSON AUDIOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
DIANA
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUDIOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568845980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 PARKSIDE COMMONS
Provider Second Line Business Mailing Address:
BOX 103-40
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30642-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-680-0085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 HARMONY XING STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATONTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31024-9548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-453-2119
Provider Business Practice Location Address Fax Number:
706-467-9068
Provider Enumeration Date:
07/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AUD004388 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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