Provider Demographics
NPI:1861491367
Name:WILSON, GEORGE B (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:B
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV173892085R0202X
SC347002085R0202X
FLME1129312085R0202X
GA679342085R0202X
AZ460282085R0202X
OH35.1220652085R0202X
UT8184938-12052085R0202X
AL359292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL197566Medicaid
AL197570Medicaid
AL248799Medicaid
WV0119544000Medicaid
AL249328Medicaid
AL197568Medicaid
AL198253Medicaid
AL249375Medicaid
AL197574Medicaid
AL220373Medicaid
AL248792Medicaid
AL249938Medicaid
AL238474Medicaid
AL248377Medicaid
WV001718794OtherBCBS
AL197573Medicaid
WV300132457OtherRAILROAD MEDICARE