Provider Demographics
NPI:1063429124
Name:WILSON, TIMOTHY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 PARKWEST BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-694-9886
Mailing Address - Fax:865-694-5023
Practice Address - Street 1:9430 PARKWEST BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-694-9886
Practice Address - Fax:865-694-5023
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0312232086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3113404OtherBCBS OF TN
TN3718742Medicaid
TN3113404OtherBCBS OF TN
TN3718742Medicaid