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General NPI Number Information
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NPI Number | 1215997028
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Entity Type | Individual
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Provider Name | CANDICE LYNN WILSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1521 DOWNTOWN WEST BLVD
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City | KNOXVILLE
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State | TN
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Zip | 37919-5407
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Country | US
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Telephone | 865-545-4592
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Fax | 865-693-8978
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Provider Business Mailing Address
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Address Line | JHQMC MOUNTAIN HOME VA; RADIOLOGY DEPARTMENT PO BOX 4000
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684-4000
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Country | US
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Telephone | 423-926-1171
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Fax | 429-979-3470
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ME94386
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 055042
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0000037867
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0000037867
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00027018
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License Number State | AL
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