Provider Demographics
NPI:1245296060
Name:WILLIAM B. WILKINSON, MD PC
Entity type:Organization
Organization Name:WILLIAM B. WILKINSON, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-331-3339
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1203
Mailing Address - Country:US
Mailing Address - Phone:256-331-3339
Mailing Address - Fax:256-331-3342
Practice Address - Street 1:523 GANDY ST NE
Practice Address - Street 2:SUITE E
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1961
Practice Address - Country:US
Practice Address - Phone:256-331-3339
Practice Address - Fax:256-331-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723179Medicaid
TN3723179Medicaid
ALG44357Medicare UPIN