| Organization Name: | WILSONMEDICALASSOCIATESLLC |
| NPI Number: | 1033431507 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EVERETT JAN WILSON (PHYSICIAN) |
| Mailing Address: | 1661 State Route 522 Unit #2 Wheelersburg |
| State: | OH US |
| Postal Code: | 456948120 |
| Phone Number: | 7405742220 |
| Fax Number: | 7405742215 |
| NPI Enumeration Date: | 02/24/2010 |
| NPI Last Update Date: | 02/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 34-002236 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |