Provider Demographics
NPI:1497045728
Name:WILSON, WILLIAM CARROLL (PA-C, MMSC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARROLL
Last Name:WILSON
Suffix:
Gender:M
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:281 N LYERLY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2728
Mailing Address - Country:US
Mailing Address - Phone:423-698-0850
Mailing Address - Fax:
Practice Address - Street 1:281 N LYERLY ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2728
Practice Address - Country:US
Practice Address - Phone:423-698-0850
Practice Address - Fax:423-698-0511
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical