Individual
JIM L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
917 W WALNUT ST, JOHNSON CITY, TN 37604-6527
(423) 439-6464
(423) 439-7118
Mailing address
P. O. BOX 699, MOUNTAIN HOME, TN 37684
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26980
TN
Other
Enumeration date
12/22/2005
Last updated
07/08/2007
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