Provider Demographics
NPI:1669154324
Name:WILSON, JANESHIA R
Entity type:Individual
Prefix:
First Name:JANESHIA
Middle Name:R
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 S PEAR ORCHARD RD STE 106-697
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4861
Mailing Address - Country:US
Mailing Address - Phone:601-460-0121
Mailing Address - Fax:
Practice Address - Street 1:552 SPRINGRIDGE RD APT G3
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5604
Practice Address - Country:US
Practice Address - Phone:601-446-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist