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General NPI Number Information
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NPI Number | 1942507140
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Entity Type | Organization
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Legal Business Name | DARREL L WILSON P.C.
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 135 N PAULINE ST FL 4-5
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City | MEMPHIS
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State | TN
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Zip | 38105-4619
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Country | US
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Telephone | 901-830-6990
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Fax | 901-624-5044
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Provider Business Mailing Address
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Address Line | 7948 WINCHESTER RD STE 109 PMB 135
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City | MEMPHIS
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State | TN
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Zip | 38125-2310
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Country | US
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Telephone | 901-830-6990
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Fax | 901-624-5044
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DARREL LENARD WILSON
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Credential |
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Telephone | 901-830-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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