Provider Demographics
NPI:1235874033
Name:JGW3 MEDICAL PLLC
Entity Type:Organization
Organization Name:JGW3 MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-600-4011
Mailing Address - Street 1:255 S 17TH ST STE 2701
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6228
Mailing Address - Country:US
Mailing Address - Phone:856-600-4011
Mailing Address - Fax:714-333-2441
Practice Address - Street 1:255 S 17TH ST STE 2701
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6228
Practice Address - Country:US
Practice Address - Phone:856-600-4011
Practice Address - Fax:714-333-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty