MEDICARE: BREEZY WILSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD.28404	AL

General Provider Information

NPI Number	:	1679785422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREEZY WILSON M.D.

Provider Business Mailing Address
First Line	:	1179 GREENMOR DR
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-6445
Country	:	US
Telephone Number	:	205-481-8530
Fax Number	:	205-481-6543

Provider Business Practice Location Address
First Line	:	1179 GREENMOR DR
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-6445
Country	:	US
Telephone Number	:	205-481-8530
Fax Number	:	205-481-6543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	05/08/2017

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Directions to “ BREEZY WILSON M.D.” Practice Location

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