Individual
JOI VENICE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1129 HALE RD, MADISON AVENUE SUITE 1031, MEMPHIS, TN 38116-6373
(901) 396-0390
Mailing address
1129 HALE RD, MEMPHIS, TN 38116-6373
(901) 396-0390
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
23902
MS
208000000X
Pediatrics Physician
Primary
52880
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2012
Last updated
06/29/2015
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