Provider Demographics
NPI:1568845980
Name:WILSON, DIANA E (AUDIOLOGIST)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:E
Last Name:WILSON
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 PARKSIDE COMMONS
Mailing Address - Street 2:BOX 103-40
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-3217
Mailing Address - Country:US
Mailing Address - Phone:865-680-0085
Mailing Address - Fax:
Practice Address - Street 1:117 HARMONY XING STE 8
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9548
Practice Address - Country:US
Practice Address - Phone:706-453-2119
Practice Address - Fax:706-467-9068
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
GAAUD004388231H00000X
NC11442237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist