Healthcare Provider Details

I. General information

NPI: 1528933108
Provider Name (Legal Business Name): DAVID WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

1216 FOREST BROOK CIR
BIRMINGHAM AL
35226-3221
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-184619
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: