Healthcare Provider Details

I. General information

NPI: 1245268283
Provider Name (Legal Business Name): JAMES G. WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST DEPARTMENT OF MEDICINE/DIVISION OF RHEUMATOLOGY
JACKSON MS
39216-4500
US

IV. Provider business mailing address

1867 CRANE RIDGE DR STE 150A UNIVERSITY INTERNAL MEDICINE ASSOCIATES, LLP
JACKSON MS
39216-4982
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5540
  • Fax:
Mailing address:
  • Phone: 601-987-3988
  • Fax: 601-987-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number07382
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: