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Individual

JOHN WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
101 MAX LANE DR, JACKSON, TN 38305-5206
(731) 427-1696
Mailing address
101 GARDEN DR, JACKSON, TN 38305-2146

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11390
TN

Other

Enumeration date
11/04/2022
Last updated
11/04/2022
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