Healthcare Provider Details

I. General information

NPI: 1265512834
Provider Name (Legal Business Name): MICHAEL WAYNE WILKERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 ALLBRITTON RD
WARRIOR AL
35180-2663
US

IV. Provider business mailing address

611 EUCLID AVE
BIRMINGHAM AL
35213-2517
US

V. Phone/Fax

Practice location:
  • Phone: 205-907-3013
  • Fax:
Mailing address:
  • Phone: 205-914-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number27664
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: