Individual
MARK DAVIS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 12TH ST W, TIFTON, GA 31794-3923
(229) 396-5335
(229) 396-5330
Mailing address
215 12TH ST W, TIFTON, GA 31794-3923
(229) 396-5335
(229) 396-5330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
069737
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69737
LICENSE
GA
Enumeration date
04/19/2010
Last updated
03/07/2023
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