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General NPI Number Information
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NPI Number | 1659805067
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Entity Type | Individual
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Provider Name | DAVID C WILSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 1924 ALCOA HWY # U56
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City | KNOXVILLE
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State | TN
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Zip | 37920-1511
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Country | US
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Telephone | 865-305-9340
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 415000-MSC8135
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City | NASHVILLE
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State | TN
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Zip | 37241-8135
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Country | US
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Telephone | 865-670-6199
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Fax | 865-670-6198
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3998
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License Number State | TN
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Taxonomy #2
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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 | 103780845
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 3998
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License Number State | TN
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