Provider Demographics
NPI:1245268283
Name:WILSON, JAMES G (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1867 CRANE RIDGE DR STE 150A
Mailing Address - Street 2:UNIVERSITY INTERNAL MEDICINE ASSOCIATES, LLP
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4982
Mailing Address - Country:US
Mailing Address - Phone:601-987-3988
Mailing Address - Fax:601-987-4165
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE/DIVISION OF RHEUMATOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MS07382207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0115310Medicaid
MS0115310Medicaid