Individual
JAMES KEENAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 VETERANS MEMORIAL BLVD S, EUPORA, MS 39744-2215
(662) 258-6221
(662) 258-9291
Mailing address
307 COLLEGE ST, WINONA, MS 38967-1901
(662) 508-5061
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
14441
MS
208D00000X
General Practice Physician
14441
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113851
—
MS
Enumeration date
07/12/2006
Last updated
06/13/2016
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