Individual
DR. WILKINS DEDWYLDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1017 JACKSON AVE, LEAKESVILLE, MS 39451-9105
(601) 394-4135
(601) 394-4455
Mailing address
2010 PAULDING RD, LEAKESVILLE, MS 39451-3055
(601) 394-2975
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
08328
MS
207Q00000X
Family Medicine Physician
Primary
08328
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01658391
—
MS
Enumeration date
01/30/2007
Last updated
02/16/2012
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