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General NPI Number Information
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NPI Number | 1982680419
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Entity Type | Individual
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Provider Name | GEORGE ANDREW WILSON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 1530 N 7TH ST SUITE 107
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City | TERRE HAUTE
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State | IN
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Zip | 47807-1057
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Country | US
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Telephone | 812-238-4900
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Fax | 812-238-4921
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Provider Business Mailing Address
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Address Line | 1530 N 7TH ST SUITE 107
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City | TERRE HAUTE
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State | IN
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Zip | 47807-1057
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Country | US
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Telephone | 812-238-4900
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Fax | 812-238-4921
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 01057579A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 01057579A
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License Number State | IN
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