Provider Demographics
NPI:1942507140
Name:DARREL L WILSON P.C.
Entity Type:Organization
Organization Name:DARREL L WILSON P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:LENARD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-830-6990
Mailing Address - Street 1:7948 WINCHESTER RD
Mailing Address - Street 2:STE 109 PMB 135
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2310
Mailing Address - Country:US
Mailing Address - Phone:901-830-6990
Mailing Address - Fax:901-624-5044
Practice Address - Street 1:135 N PAULINE ST FL 4-5
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4619
Practice Address - Country:US
Practice Address - Phone:901-830-6990
Practice Address - Fax:901-624-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty