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General NPI Number Information
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NPI Number | 1093851313
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Entity Type | Organization
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Legal Business Name | TENNESSEE VALLEY GASTROENTEROLOGY
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 416 N. SEMINARY STREET STE 3100
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City | FLORENCE
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State | AL
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Zip | 35630
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Country | US
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Telephone | 256-766-8667
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Fax | 256-767-5327
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Provider Business Mailing Address
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Address Line | 416 N. SEMINARY STREET SUITE 3100
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City | FLORENCE
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State | AL
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Zip | 35630
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Country | US
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Telephone | 256-766-8667
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Fax | 256-767-5327
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JASON WILKES
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Credential | M.D.
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Telephone | 256-766-8667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00006975
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | AL
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