=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528241924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HENRY B WILSON MD PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2007
-----------------------------------------------------
Last Update Date | 12/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 MURPHY AVE SUITE 409
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-327-4603
-----------------------------------------------------
Fax | 615-327-4606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2201 MURPHY AVE SUITE 409
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37203-1835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-327-4603
-----------------------------------------------------
Fax | 615-327-4606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HENRY B WILSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 615-327-4603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------