Doctor Name: | JAMES KEENAN WILSON |
NPI Number: | 1003841354 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 14441 |
Business Practice Address: | 500 Veterans Memorial Blvd S Eupora, MS - 397442215 |
Business Phone Number: | 6622586221 |
Business Fax Number: | 6622589291 |
Mailing Address: | 307 College St, WINONA |
State: | MS |
Postal Code: | 389671901 |
Phone Number: | 6625085061 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2006 |
NPI Last Update Date: | 06/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 14441 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MS |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |