Individual
WILBURN EDWIN GEORGE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 NORTH JACKSON STREET, TULLAHOMA, TN 37388
(931) 393-7831
(931) 393-7833
Mailing address
PO BOX 938, TULLAHOMA, TN 37388
(931) 393-7831
(931) 393-7833
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD10360
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3014316
—
TN
01
—
58479
BLUECROSS
TN
Enumeration date
04/22/2006
Last updated
01/20/2015
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