Healthcare Provider Details

I. General information

NPI: 1538515069
Provider Name (Legal Business Name): ROBYN WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26746 MAIN ST
ARDMORE AL
35739-7624
US

IV. Provider business mailing address

26746 MAIN ST
ARDMORE AL
35739-7624
US

V. Phone/Fax

Practice location:
  • Phone: 256-693-2300
  • Fax: 256-693-5800
Mailing address:
  • Phone: 256-693-2300
  • Fax: 256-693-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47851
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59670
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: