Individual
DR. JOHN M. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 RIVERMONT AVE, LYNCHBURG, VA 24503-2030
(434) 200-5999
Mailing address
1204 FENWICK DR, LYNCHBURG, VA 24502-2112
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101056617
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
186475
ANTHEM PROVIDER NUMBER
VA
01
—
2019602
CIGNA BEHAVIOR PROVIDER N
—
01
—
203639329001
TRICARE PROVIDER NUMBER
VA
01
—
239524
VALUE OPTIONS PROVIDER NU
—
01
—
O88170
SENTARA PROVIDER NUMBER
VA
Enumeration date
08/03/2005
Last updated
03/13/2008
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