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General NPI Number Information
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NPI Number | 1629359419
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Entity Type | Organization
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Legal Business Name | D. WILSON INC.
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 09/07/2011
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Provider Practice Location Address
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Address Line | 121 SOUTH MAIN STREET UNIT A
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City | REIDSVILLE
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State | GA
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Zip | 30453
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Country | US
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Telephone | 912-557-1087
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Fax | 912-557-1087
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Provider Business Mailing Address
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Address Line | PO BOX 2386
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City | REIDSVILLE
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State | GA
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Zip | 30453-2386
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Country | US
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Telephone | 912-557-1087
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Fax | 912-557-1087
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID WILSON
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Credential |
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Telephone | 912-557-1087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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