Provider Demographics
NPI:1225034770
Name:WILSON, WINTER B (DO)
Entity Type:Individual
Prefix:DR
First Name:WINTER
Middle Name:B
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ROWE DR
Mailing Address - Street 2:STE C
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7366
Mailing Address - Country:US
Mailing Address - Phone:256-753-8810
Mailing Address - Fax:256-753-8880
Practice Address - Street 1:55 ROWE DR
Practice Address - Street 2:STE C
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7366
Practice Address - Country:US
Practice Address - Phone:256-753-8810
Practice Address - Fax:256-753-8880
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD966Medicare PIN
ALC42410Medicare UPIN