Individual
JACOB WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
333 WHITESPORT DR SW STE 204, HUNTSVILLE, AL 35801-3455
(256) 715-5001
Mailing address
333 WHITESPORT DR SW STE 204, HUNTSVILLE, AL 35801-3455
(256) 715-5001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36564
AL
Other
Enumeration date
05/18/2016
Last updated
07/01/2020
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