Wilson, Earl Keith

Wilson, Earl Keith is an individual health care provider with primary practice located at 3183 W State St Suite 1201, Bristol TN 37620-1712. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Wilson, Earl Keith can be contacted via phone (423) 764-0987.

Contact Information

Primary practice address
3183 W State St Suite 1201 Bristol TN 37620-1712
Phone: (423) 764-0987
Fax: (423) 652-2512
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 13090 Tennessee

Profile Details

NPI number 1568455244
LBN Legal business name Wilson, Earl Keith
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 26th, 2005
Last updated Jul 17th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568455244 NPPES
Tennessee MEDICAID 3183937
Tennessee MEDICAID 7100018090
Tennessee MEDICAID 69855
Tennessee MEDICAID 006193676
Tennessee MEDICAID 010363276

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