Individual
GEORGE ANDREW WILSON JR.
Active
Individual
GEORGE ANDREW WILSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01057579A
IN
207T00000X
Neurological Surgery Physician
Primary
01057579A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000295844
BLUE CROSS
IN
05
—
200452000A
—
IN
01
—
ICHIA
ICHIA
IN
01
—
P00058804
PALM
IN
Enumeration date
12/16/2005
Last updated
08/23/2019
Update your record
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