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General NPI Number Information
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NPI Number | 1598911877
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Entity Type | Organization
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Legal Business Name | GEORGE E. WILKERSON, M.D., P.A.
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 348 CROSSGATES BLVD STE 2300
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City | BRANDON
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State | MS
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Zip | 39042-2634
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Country | US
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Telephone | 601-824-4354
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Fax | 601-824-6042
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Provider Business Mailing Address
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Address Line | 348 CROSSGATES BLVD STE 2300
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City | BRANDON
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State | MS
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Zip | 39042-2634
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Country | US
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Telephone | 601-824-4354
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Fax | 601-824-6042
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE EDWARD WILKERSON
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Credential | M.D.
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Telephone | 601-824-4354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 05507
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License Number State | MS
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