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General NPI Number Information
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NPI Number | 1629605852
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Entity Type | Individual
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Provider Name | COREY WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 600 HILL AVE STE 101
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City | NASHVILLE
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State | TN
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Zip | 37210-4755
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Country | US
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Telephone | 615-329-4790
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Fax |
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Provider Business Mailing Address
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Address Line | 550 HARBOR COVE LN APT 2300J
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City | CHARLESTON
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State | SC
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Zip | 29412-3031
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Country | US
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Telephone | 803-427-7602
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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