Provider Demographics
NPI:1356308779
Name:WILSON, SHARON RENEE (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RENEE
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 1:918 WALDKIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2427
Mailing Address - Country:US
Mailing Address - Phone:662-377-5930
Mailing Address - Fax:662-377-5085
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 680
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-865-3322
Practice Address - Fax:615-467-6692
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114983Medicaid
MS00114983Medicaid
MSF76652Medicare UPIN