=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235872482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ALLISON WILSON MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2022
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3525 INDEPENDENCE DR
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-5709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-971-2475
-----------------------------------------------------
Fax | 205-971-2476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4200 COLONNADE PKWY
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-2342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-971-7613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD.49325
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------