Mark Davis Wilson
Pediatrician
1909 Us Highway 82 W Ste 3&4
Tifton
, Georgia 31793
Mark Davis Wilson
Pediatrician
1909 Us Highway 82 W Ste 3&4
Tifton
, Georgia 31793
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About
Features
Specialties
- Pediatrician
Languages spoken
- English
Location
First Address
- Mark Davis Wilson
- Po Box 5610
- Cordele, GA
- Zip : 31010-5610
- Phone :
Second Address
- Mark Davis Wilson
- 1909 Us Highway 82 W Ste 3&4
- Tifton, GA
- Zip : 31793
- Fax : (229) 445-3513
- Phone : (229) 445-3509
Reviews
FAQs
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What type of doctor is Mark Davis Wilson
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | 069737 | GA |
National Provider Identifier
| NPI | 1003132754 |
|---|---|
| Provider Name | Mark Davis Wilson |
| First Address | Cordele, GA 31010-5610 |
| Second Address | Tifton, GA 31793 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/04/2010 |
| Last Update Date | 20/05/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 69737 | LICENSE (01) | GA |
| FW3838729 | DEA (01) | GA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.