Individual
JOSEPH L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1901 MISSION 66, VICKSBURG, MS 39180-3711
(601) 636-0097
(601) 629-9969
Mailing address
1901 MISSION 66, VICKSBURG, MS 39180-3711
(601) 636-0097
(601) 629-9969
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10040
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010895
—
MS
Enumeration date
09/21/2006
Last updated
07/08/2007
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