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NPI Code Detail

MEDICARE: DR. JOHN KEENAN WILSON MD

MEDICARE: DR. JOHN KEENAN WILSON MD
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
1207R00000XInternal Medicine Physician01055539AIN

General Provider Information

NPI Number : 1922007467
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN KEENAN WILSON MD
Provider Business Mailing Address
First Line : 511 AUMOND RD
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-3305
Country : US
Telephone Number : 706-737-6062
Fax Number :
Provider Business Practice Location Address
First Line : 300 W HOSPITAL RD
Second Line : BUILDING 300
City : FORT GORDON
State : GA
Zip : 30905-5741
Country : US
Telephone Number : 706-787-6945
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 07/08/2007

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