MEDICARE: GEORGE GEOFFREY WILSON JR. DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	36822	MS

General Provider Information

NPI Number	:	1073193009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE GEOFFREY WILSON JR. DO

Provider Business Mailing Address
First Line	:	440 PEGRAM DR
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-6319
Country	:	US
Telephone Number	:	662-844-5344
Fax Number	:	662-841-0407

Provider Business Practice Location Address
First Line	:	3200 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1297
Country	:	US
Telephone Number	:	304-388-5590
Fax Number	:	304-388-8238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	03/16/2026

Similar Medicare Providers

1053363127 — BRADLEY NINE MD
Practice Location Address:

3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1297

Practice Phone: 304-388-5432
Practice Fax:

1790729614 — MR. JEREMY TODD JORDAN PA-C, MBA
Practice Location Address:

3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1297

Practice Phone: 304-388-5432
Practice Fax:

1861594558 — DR. JAMES M MEARS M.D.
Practice Location Address:

3200 MACCORKLE AVE SE FL 5
CHARLESTON, WV
25304-1297

Practice Phone: 304-388-4600
Practice Fax: 304-388-4603

1831296136 — ELIZABETH J KENT LICSW
Practice Location Address:

3200 MACCORKLE AVE SE , FL 5
CHARLESTON, WV
25304-1297

Practice Phone: 304-388-1000
Practice Fax: 304-388-1021

1871684696 — MRS. CARRIE J SMITH PT
Practice Location Address:

3200 MACCORKLE AVE SE
CHARLESTON, WV
25304-1297

Practice Phone: 304-388-5432
Practice Fax:

1366581647 — MRS. FAITH ANNETTE GRIFFITH FNP-BC
Practice Location Address:

3200 MACCORKLE AVE SE FL 4
CHARLESTON, WV
25304-1297

Practice Phone: 304-388-8199
Practice Fax: 304-388-8195

Directions to “ GEORGE GEOFFREY WILSON JR. DO” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.