Organization
NELSON WILSON, IV
Active
Other names
Extended Care Prosthetics of Mississippi
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NELSON WILSON IV C.P. (OWNER)
(601) 951-7012
Entity
Organization
Contact information
Practice address
801 E NORTHSIDE DR, SUITE D, CLINTON, MS 39056-3663
(601) 924-2888
(601) 924-2885
Mailing address
801 E NORTHSIDE DR, SUITE D, CLINTON, MS 39056-3663
(601) 924-2888
(601) 924-2885
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
C36423
MS
Other
Enumeration date
04/27/2009
Last updated
05/19/2009
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