MEDICARE: GEORGE S. WILSON, DO INC.

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1619388832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE S. WILSON, DO INC.

Provider Business Mailing Address
First Line	:	356 E LINCOLN WAY
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-1443
Country	:	US
Telephone Number	:	330-420-0200
Fax Number	:	330-420-0210

Provider Business Practice Location Address
First Line	:	356 E LINCOLN WAY
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-1443
Country	:	US
Telephone Number	:	330-420-0200
Fax Number	:	330-420-0210

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. GEORGE SCOTT WILSON
Credential	:	DO
Telephone Number	:	330-420-0200

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	05/09/2014

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