Provider Demographics
NPI:1902861552
Name:WILBANKS, JAMES GREG (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GREG
Last Name:WILBANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3400 HIGHWAY 78 E
Mailing Address - Street 2:SUITE 318
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8907
Mailing Address - Country:US
Mailing Address - Phone:205-221-4801
Mailing Address - Fax:205-221-4802
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:SUITE 318
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8907
Practice Address - Country:US
Practice Address - Phone:205-221-4801
Practice Address - Fax:205-221-4802
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL13568208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51036493OtherBLUE CROSS
AL000036493Medicaid
AL36493Medicare ID - Type Unspecified
C76922Medicare UPIN