Wilson, Mark Davis
Wilson, Mark Davis is an individual health care provider with primary practice located at 215 12Th St W , Tifton GA 31794-3923. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Wilson, Mark Davis can be contacted via phone (229) 396-5335.Contact Information
Primary practice address
215 12Th St W
Tifton GA 31794-3923
Phone: (229) 396-5335
Fax: (229) 396-5330
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 069737 | Georgia |
Profile Details
| NPI number | 1003132754 |
|---|---|
| LBN Legal business name | Wilson, Mark Davis |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 19th, 2010 |
| Last updated | Mar 7th, 2023 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003132754 | NPPES |
| Georgia | Other | 69737 | LICENSE |
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