MEDICARE: SHEILA CARNES WILSON LCSW

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	1041C0700X	Clinical Social Worker	2082C	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51539253	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1821122359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA CARNES WILSON LCSW

Provider Business Mailing Address
First Line	:	852 GREENHILLS DR SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-6004
Country	:	US
Telephone Number	:	256-328-4744
Fax Number	:	423-507-8791

Provider Business Practice Location Address
First Line	:	744 TELL ST
Second Line	:	SUITE 100
City	:	ATHENS
State	:	TN
Zip	:	37303-3148
Country	:	US
Telephone Number	:	423-507-8826
Fax Number	:	423-507-8791

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/27/2011

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