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Organization

GEORGE E. WILKERSON, M.D., P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GEORGE EDWARD WILKERSON M.D. (PRESIDENT)
(601) 824-4354
Entity
Organization

Contact information

Practice address
348 CROSSGATES BLVD STE 2300, BRANDON, MS 39042-2634
(601) 824-4354
(601) 824-6042
Mailing address
348 CROSSGATES BLVD STE 2300, BRANDON, MS 39042-2634
(601) 824-4354
(601) 824-6042

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
05507
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00014453
MS
01
130000173
MEDICARE ID - TYPE UNSPECIFIED
MS
Enumeration date
08/18/2008
Last updated
08/18/2008
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