Healthcare Provider Details

I. General information

NPI: 1477131530
Provider Name (Legal Business Name): TIMBERLY WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 GORDON SMITH DR
MOBILE AL
36617-2318
US

IV. Provider business mailing address

PO BOX 35752
BELFAST ME
04915-0635
US

V. Phone/Fax

Practice location:
  • Phone: 251-434-3475
  • Fax: 251-434-3837
Mailing address:
  • Phone: 251-434-3475
  • Fax: 251-434-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.47963
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: