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General NPI Number Information
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NPI Number | 1558704387
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Entity Type | Individual
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Provider Name | MRS. JOANN WILSON
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Gender | Female
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 1766 OLD LELAND RD
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City | GREENVILLE
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State | MS
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Zip | 38703
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Country | US
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Telephone | 662-537-4976
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Fax | 662-537-4977
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Provider Business Mailing Address
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Address Line | 1766 OLD LELAND RD
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City | GREENVILLE
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State | MS
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Zip | 38703
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Country | US
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Telephone | 662-537-4976
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Fax | 662-537-4977
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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 | 172A00000X
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Taxonomy Name | Driver
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License Number | 801597391
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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