MEDICARE: DR. CANDICE LYNN WILSON M.D.

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	174400000X	Specialist	ME94386	FL
2	174400000X	Specialist	055042	GA
3	174400000X	Specialist	0000037867	TN
4	2085R0202X	Diagnostic Radiology Physician	0000037867	TN
5	174400000X	Specialist	00027018	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1882432	OTHER	TN	FIRST HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9495633	OTHER	TN	CIGNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4184755	OTHER	TN	BCBS OF TN

General Provider Information

NPI Number	:	1215997028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE LYNN WILSON M.D.

Provider Business Mailing Address
First Line	:	JHQMC MOUNTAIN HOME VA; RADIOLOGY DEPARTMENT
Second Line	:	PO BOX 4000
City	:	MOUNTAIN HOME
State	:	TN
Zip	:	37684-4000
Country	:	US
Telephone Number	:	423-926-1171
Fax Number	:	429-979-3470

Provider Business Practice Location Address
First Line	:	1521 DOWNTOWN WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5407
Country	:	US
Telephone Number	:	865-545-4592
Fax Number	:	865-693-8978

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	12/04/2025

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