Healthcare Provider Details

I. General information

NPI: 1912935495
Provider Name (Legal Business Name): JILL A WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL A HOLLINGSWORTH M.D.

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/27/2023
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 E WASHINGTON ST SUITE 300
INDIANAPOLIS IN
46219-6803
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-9220
  • Fax: 317-355-9230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01055866A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: