Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | DO0000002339 | TN |
NPI | 1205002227 |
---|---|
Provider Name | Dr. Brad P Wilson |
First Address | Hendersonville, TN 37075-2366 |
Second Address | Hendersonville, TN 37075-2366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2008 |
Last Update Date | 12/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1531353 | (05) | TN |