Individual
MR. MARK A WILSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5946 WRIGHT DR, BATON ROUGE, LA 70812-2318
(225) 223-5363
Mailing address
5946 WRIGHT DR, BATON ROUGE, LA 70812-2318
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
LA
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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