Provider Demographics
NPI:1114966694
Name:WILSON, FELICIA M (MD)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-410-5437
Mailing Address - Fax:251-434-3852
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:STE 1S
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-410-5437
Practice Address - Fax:251-434-3852
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL169282080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255633200Medicaid
AL36-10164OtherUNITED HEALTH CARE
AL000087800Medicaid
MS00111185Medicaid
AL51087800OtherBLUE CROSS
AL36-10164OtherUNITED HEALTH CARE
FL255633200Medicaid