Healthcare Provider Details

I. General information

NPI: 1821252776
Provider Name (Legal Business Name): G. CHASE WILSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 KINGSTON PIKE
KNOXVILLE TN
37919-4863
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 865-633-0235
  • Fax: 865-602-7757
Mailing address:
  • Phone: 865-243-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number49109
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number49109
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: