| Doctor Name: | JAMES WILSON |
| NPI Number: | 1063577682 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 101 |
| Business Practice Address: | 1679 Highway 243 South Marianna, AR - 72360 |
| Business Phone Number: | 8702953557 |
| Business Fax Number: | 8702953686 |
| Mailing Address: | 1679 Highway 243 South, MARIANNA |
| State: | AR |
| Postal Code: | 72360 |
| Phone Number: | 8702953557 |
| Fax Number: | 8702953686 |
| NPI Enumeration Date: | 12/26/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 177F00000X |
| License Number: | 101 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Lodging |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home. |