Healthcare Provider Details

I. General information

NPI: 1457807349
Provider Name (Legal Business Name): ELIZABETH WILSON FORWOOD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN WILSON PA

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 INDUSTRIAL PKWY STE H
SARALAND AL
36571-3743
US

IV. Provider business mailing address

880 INDUSTRIAL PKWY STE H
SARALAND AL
36571-3743
US

V. Phone/Fax

Practice location:
  • Phone: 251-414-5900
  • Fax: 251-445-8859
Mailing address:
  • Phone: 251-414-5900
  • Fax: 251-445-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: