Individual
EARL KEITH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3183 W STATE ST, SUITE 1201, BRISTOL, TN 37620-1712
(423) 764-0987
(423) 652-2512
Mailing address
3183 W STATE ST, SUITE 1201, BRISTOL, TN 37620-1712
(423) 764-0987
(423) 652-2512
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
13090
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006193676
—
VA
05
—
010363276
—
VA
05
—
3183937
—
TN
05
—
69855
—
TN
05
—
7100018090
—
KY
Enumeration date
08/26/2005
Last updated
07/17/2012
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