Individual
ANDREW STEVEN WILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-4847
(423) 431-3949
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 433-6039
(423) 433-6060
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
52834
TN
208000000X
Pediatrics Physician
LL34830
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902168537
—
VA
05
—
Q014921
—
TN
Enumeration date
06/11/2012
Last updated
01/29/2024
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