| Doctor Name: | LISA A WILSON |
| NPI Number: | 1558363275 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 003755 |
| Business Practice Address: | 1061 Harmon Ave. Ste 1d03 Ft. Stewart, GA - 313145674 |
| Business Phone Number: | 9124355595 |
| Business Fax Number: | 9124355646 |
| Mailing Address: | 1061 Harmon Ave. Ste 1d03, FT. STEWART |
| State: | GA |
| Postal Code: | 313145674 |
| Phone Number: | 9124355595 |
| Fax Number: | 9124355646 |
| NPI Enumeration Date: | 08/12/2005 |
| NPI Last Update Date: | 09/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 003755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |