Provider Demographics
NPI:1619388832
Name:GEORGE S. WILSON, DO INC.
Entity Type:Organization
Organization Name:GEORGE S. WILSON, DO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-420-0200
Mailing Address - Street 1:356 E LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1443
Mailing Address - Country:US
Mailing Address - Phone:330-420-0200
Mailing Address - Fax:330-420-0210
Practice Address - Street 1:356 E LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1443
Practice Address - Country:US
Practice Address - Phone:330-420-0200
Practice Address - Fax:330-420-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty