Healthcare Provider Details

I. General information

NPI: 1184641102
Provider Name (Legal Business Name): DAILEY & WILKERSON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 DICKERSON DR
JASPER TX
75951-5111
US

IV. Provider business mailing address

PO BOX 312
JASPER TX
75951-0004
US

V. Phone/Fax

Practice location:
  • Phone: 409-383-5200
  • Fax: 409-383-5202
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. YOLANDA BABINEAUX
Title or Position: OFFICE MANAGER
Credential:
Phone: 409-383-5200