Individual
SHENELLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2204 PAVILION DR STE 310, KINGSPORT, TN 37660-4653
(423) 246-4155
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
36843
AL
208800000X
Urology Physician
Primary
85818
GA
Other
Enumeration date
08/01/2012
Last updated
02/06/2026
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