Provider Demographics
NPI:1679511190
Name:PLAZA WILSON DME INC
Entity Type:Organization
Organization Name:PLAZA WILSON DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-237-6621
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-0909
Mailing Address - Country:US
Mailing Address - Phone:478-237-2227
Mailing Address - Fax:478-237-2217
Practice Address - Street 1:204 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3648
Practice Address - Country:US
Practice Address - Phone:478-237-2227
Practice Address - Fax:478-237-2217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0228700001Medicare ID - Type Unspecified