Provider Demographics
NPI:1063879005
Name:UROLOGY CLINICS OF NORTH TEXAS, PLLC
Entity type:Organization
Organization Name:UROLOGY CLINICS OF NORTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-691-1902
Mailing Address - Street 1:7515 GREENVILLE AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3831
Mailing Address - Country:US
Mailing Address - Phone:214-691-1902
Mailing Address - Fax:
Practice Address - Street 1:971 BROAD ST
Practice Address - Street 2:#3
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-7225
Practice Address - Country:US
Practice Address - Phone:706-434-2600
Practice Address - Fax:706-434-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty