Healthcare Provider Details

I. General information

NPI: 1225008683
Provider Name (Legal Business Name): WOODROW R WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N CAROTHERS RD
FRANKLIN TN
37067-5822
US

IV. Provider business mailing address

PO BOX 3330
CLARKSVILLE TN
37043-3330
US

V. Phone/Fax

Practice location:
  • Phone: 615-791-2682
  • Fax:
Mailing address:
  • Phone: 931-647-5034
  • Fax: 931-552-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: