Provider Demographics
NPI:1942397971
Name:WILSON, THOMAS A JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:WILSON
Suffix:JR
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 1:800 ST VINCENTS DRIVE
Mailing Address - Street 2:#700
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-933-8981
Mailing Address - Fax:205-930-0746
Practice Address - Street 1:800 ST VINCENTS DRIVE
Practice Address - Street 2:#700
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-933-8981
Practice Address - Fax:205-930-0746
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17154207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL52820186Medicaid
AL52820186Medicaid