Provider Demographics
NPI:1316958747
Name:WILSON, GARLAND A (MD)
Entity type:Individual
Prefix:MR
First Name:GARLAND
Middle Name:A
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 LANTANA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-1903
Mailing Address - Country:US
Mailing Address - Phone:931-484-5141
Mailing Address - Fax:931-484-5620
Practice Address - Street 1:100 LANTANA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-1903
Practice Address - Country:US
Practice Address - Phone:931-484-5141
Practice Address - Fax:931-484-5141
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD36129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1689631137OtherGROUP NPI
TN3876794Medicaid
TN4066103OtherBLUE CROSS
P00019568OtherRAILROAD MEDICARE
TN3373352OtherUFP MEDICARE GRP
TN3373352OtherUFP MEDICAID GRP
TN3876794Medicare ID - Type Unspecified
TN1689631137OtherGROUP NPI
TN3876794Medicaid