Provider Demographics
NPI:1841412764
Name:WILSON, BILL EARL (DPH)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:EARL
Last Name:WILSON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MERMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3446
Mailing Address - Country:US
Mailing Address - Phone:423-239-5306
Mailing Address - Fax:
Practice Address - Street 1:1911 MORELAND DRIVE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3018
Practice Address - Country:US
Practice Address - Phone:423-239-0679
Practice Address - Fax:423-239-0673
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist