Provider Demographics
NPI:1821282070
Name:JAMES GREG WILBANKS
Entity Type:Organization
Organization Name:JAMES GREG WILBANKS
Other - Org Name:WINFIELD PEDIATRIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:WILBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-221-4801
Mailing Address - Street 1:3400 HIGHWAY 78 E
Mailing Address - Street 2:SUITE 318
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8907
Mailing Address - Country:US
Mailing Address - Phone:205-221-4801
Mailing Address - Fax:205-221-4802
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:STE 318
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8907
Practice Address - Country:US
Practice Address - Phone:205-221-4801
Practice Address - Fax:205-221-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13568208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529500800Medicaid