Individual
JACOB WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1313 21ST AVENUE, SOUTH, 703 OXFORD HOUSE, NASHVILLE, TN 37232-4700
(615) 936-0087
Mailing address
1313 21ST AVE, S, 703 OXFORD HOUSE, NASHVILLE, TN 37232-4700
(615) 936-0087
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
60281
TN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/12/2018
Last updated
06/30/2020
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