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General NPI Number Information
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NPI Number | 1811256084
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Entity Type | Individual
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Provider Name | PHILIP THOMAS WILSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 4370 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36305-1056
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Country | US
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Telephone | 334-794-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 105 S WOODBURN DR STE 2
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City | DOTHAN
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State | AL
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Zip | 36305-1109
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS12983
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO.1272
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License Number State | AL
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