Individual
MR. GEORGE DEAN WILSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 WOODLAWN DRIVE, JOHNSON CITY, TN 37602-5978
(423) 928-6174
(423) 926-2258
Mailing address
3908 MARABLE LANE, JOHNSON CITY, TN 37601
(423) 283-4677
(423) 283-9722
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD011166
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0118991
BCBS
TN
01
—
0140000775
CIGNA
—
01
—
1292658
UMWA
—
01
—
130014480
RR MEDICARE
TN
01
—
164888600
OWCP GROUP ID
TN
05
—
3168835
—
TN
01
—
602005579
PHP CARITEN
—
05
—
6196853
—
VA
05
—
64796980
—
KY
05
—
7906816
—
NC
01
—
A55508
JOHN DEERE
—
Enumeration date
05/23/2006
Last updated
03/03/2009
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