Provider Demographics
NPI:1609679299
Name:WILSON, HANNAH GRACE (APRN)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:WILSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 WILLOW HAVEN ST SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-4847
Mailing Address - Country:US
Mailing Address - Phone:706-263-6142
Mailing Address - Fax:
Practice Address - Street 1:304 BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4815
Practice Address - Country:US
Practice Address - Phone:706-876-1870
Practice Address - Fax:706-277-7626
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily