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NPI Code Detail

MEDICARE: TERRI M WILSON M.D.

MEDICARE: TERRI M 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
1207Q00000XFamily Medicine Physician034494GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C16001OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467549170
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRI M WILSON M.D.
Provider Business Mailing Address
First Line : 101 HOUSTON ST
Second Line :
City : BARNESVILLE
State : GA
Zip : 30204-1660
Country : US
Telephone Number : 770-358-1961
Fax Number : 770-358-9233
Provider Business Practice Location Address
First Line : 101 HOUSTON ST
Second Line :
City : BARNESVILLE
State : GA
Zip : 30204-1660
Country : US
Telephone Number : 770-358-1961
Fax Number : 770-358-9233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 05/08/2008

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