Healthcare Provider Details

I. General information

NPI: 1942507140
Provider Name (Legal Business Name): DARREL L WILSON P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N PAULINE ST FL 4-5
MEMPHIS TN
38105-4619
US

IV. Provider business mailing address

7948 WINCHESTER RD STE 109 PMB 135
MEMPHIS TN
38125-2310
US

V. Phone/Fax

Practice location:
  • Phone: 901-830-6990
  • Fax: 901-624-5044
Mailing address:
  • Phone: 901-830-6990
  • Fax: 901-624-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DARREL LENARD WILSON
Title or Position: PRESIDENT
Credential:
Phone: 901-830-6990