| Doctor Name: | MR. GEORGE MARCUS WILSON |
| NPI Number: | 1205011327 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | |
| Business Practice Address: | 1425 W Main St Walnut Ridge, AR - 724761431 |
| Business Phone Number: | 8708865303 |
| Business Fax Number: | 8708867002 |
| Mailing Address: | 1815 Pleasant Grove Rd, JONESBORO |
| State: | AR |
| Postal Code: | 724017870 |
| Phone Number: | 8709336886 |
| Fax Number: | 8709339395 |
| NPI Enumeration Date: | 01/08/2008 |
| NPI Last Update Date: | 02/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |