MEDICARE: JOHN WELLS WILSON MD

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	25140	AL
2	208600000X	Surgery Physician	12762	MS
3	208600000X	Surgery Physician	25140	AL

Other Identifiers

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

General Provider Information

NPI Number	:	1982790010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WELLS WILSON MD

Provider Business Mailing Address
First Line	:	P.O. BOX 1105
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36533
Country	:	US
Telephone Number	:	251-990-9191
Fax Number	:	251-990-9189

Provider Business Practice Location Address
First Line	:	188 HOSPITAL DR STE 205
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-2038
Country	:	US
Telephone Number	:	251-990-9191
Fax Number	:	251-990-9189

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	05/17/2022

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Directions to “ JOHN WELLS WILSON MD” Practice Location

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