| Doctor Name: | BILLY DWAYNE WILSON |
| NPI Number: | 1801231915 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1208 Madison Ter Glenn Heights, TX - 751548833 |
| Business Phone Number: | 2145575512 |
| Business Fax Number: | 9722740811 |
| Mailing Address: | 1208 Madison Ter, GLENN HEIGHTS |
| State: | TX |
| Postal Code: | 751548833 |
| Phone Number: | 2145575512 |
| Fax Number: | 9722740811 |
| NPI Enumeration Date: | 05/02/2013 |
| NPI Last Update Date: | 05/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |