MARK DAVIS WILSON (NPI# 1003132754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003132754 |
| Entity Type | Individual |
| Full Name | MARK DAVIS WILSON |
| Credential | M.D. |
| Practice Address |
1909 Us Highway 82 W Ste 3&4 Tifton GA 31793 |
| Mailing Address |
Po Box 5610 Cordele GA 31010-5610 |
| Practice Telephone | 2294453509 |
| Practice Fax Number | 2294453513 |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2019-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 069737 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | LICENSE | 69737 | 01 |
| GA | DEA | FW3838729 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 155 Professional Dr, Baldwin, GA 30511 | 7067762368 | 7067762589 |
| 39 Kent Rd, Suite 5, Tifton, GA 317941698 | 2293537337 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518313089 | Mark Wilson | Military Health Care Provider | 1101 Grade Ln, 123 Special Tactics, Louisville, KY 40213-2673 | 2016-05-13 |
| 1750736088 | Mark Wilson | Clinic/Center | 5313 Ogden St, Philadelphia, PA 19139-1438 | 2016-04-23 |
| 1992123285 | Mark Wilson | Occupational Therapist | 2820 Roosevelt Road Ste 105, San Diego, CA 92106 | 2014-04-03 |
| 1053611699 | Mark Leo Wilson | Pharmacist | 5049 S 13th St, Leavenworth, KS 66048-5581 | 2010-10-29 |
| 1013076405 | Mark R Wilson | Acupuncturist | 11573 Los Osos Valley Rd Ste H, San Luis Obispo, CA 93405-6497 | 2006-12-08 |
| 1700950771 | Mark Wilson | Chiropractor | 2300 Great Northern Ave Ste B, Missoula, MT 59808-1726 | 2006-11-20 |
| 1578633046 | Mark K Wilson | Dentist | 107 N Maple, Osceola, AR 72370 | 2006-11-09 |
| 1437239357 | Mark A. Wilson | Dentist | 400 Duncan Station Rd, Mckeesport, PA 15135-3333 | 2006-10-16 |
| 1831287267 | Mark S Wilson | Anesthesiology | 4444 Corona Dr Ste 215, Corpus Christi, TX 78411-4300 | 2006-10-11 |
| 1679660682 | Mark Wilson | Emergency Medicine | 2801 Franciscan Drive, St. Joseph's Regional Health System- Emergency Dept., Bryan, TX 77802 | 2006-10-10 |
| Street Address |
1909 US HIGHWAY 82 W STE 3&4 |
| City | TIFTON |
| State | GA |
| Zip Code | 31793 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255983466 | Jessica Lauren Lee | Nurse Practitioner | 1909 Us Highway 82 W Ste 3&4, Tifton, GA 31793-8200 | 2019-07-09 |
| 1003371790 | Ana Alicia Gomez Nova | Nurse Practitioner | 1909 Us Highway 82 W Ste 3&4, Tifton, GA 31793-8200 | 2019-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508428442 | Tift Regional Health System Inc | Nurse Practitioner | 1464 Carpenter Road S, Tifton, GA 31793 | 2019-07-01 |
| 1528556990 | Careconnect Health, Inc. | Clinic/Center | 1909 Hwy. 82 West, Suites 3 & 4, Tifton, GA 31793 | 2018-05-01 |
| 1003982752 | Leanette S Roberson | Counselor | 1603 Mallard Lane, Tifton, GA 31793 | 2006-11-27 |
| 1356447536 | Tift County Comissioner of Roads & Revenues | Ambulance | 1209 N Tifton Avenue, Tifton, GA 31793 | 2006-09-15 |
| 1295063956 | Fran Mcpherson | Nurse Practitioner | 2201 Rutland Rd, Tifton, GA 31793-5026 | 2009-11-18 |
| 1710542451 | Tiffany Kennedy | Contractor | 2770 Eb Hamilton Dr Apt 203, Tifton, GA 31793-5060 | 2019-05-08 |
| 1801948229 | Frank M Davis | Family Medicine | 67 Hutchinson Rd, Tifton, GA 31793-5551 | 2007-01-17 |
| 1629552237 | Allison M Holland | Contractor | 166 Cambridge Ct, Tifton, GA 31793-5675 | 2018-09-19 |
| 1215189865 | Cindia Poole Dubravcic | Nurse Practitioner | 2802 Moore Hwy, Abac, Tifton, GA 31793-5679 | 2008-10-15 |
| 1891038568 | Abraham Baldwin Agricultural College | Clinic/Center | 2802 Moore Hwy, Abac 52, Tifton, GA 31793-5679 | 2013-04-01 |
| Find all providers in zip 31793 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750402731 | Nikkia F. Johnson | Pediatrics | 39 Kent Rd Ste 5, Tifton, GA 31794-1697 | 2007-04-03 |
| 1952482135 | Nandlal Chainani | Pediatrics | 1610 John Orr Dr, Bldg E, Tifton, GA 31794-3682 | 2006-10-17 |
| 1932556453 | Priscilla Amoah | Pediatrics | 39 Kent Rd Ste 5, Tifton, GA 31794-1697 | 2016-05-16 |
| 1619322328 | Nicholas Webster | Pediatrics | 39 Kent Rd Ste 5, Tifton, GA 31794-1697 | 2016-05-01 |
| 1891106795 | Henry Leboyd IIi | Pediatrics | 901 18th St E, Tifton, GA 31794-3648 | 2014-05-13 |
| 1184042228 | Rebecca Condon Staub | Pediatrics | 39 Kent Rd Ste 5, Tifton, GA 31794-1697 | 2014-04-05 |
| 1285992073 | Kimberly Nicole Works | Pediatrics | 39 Kent Rd, Suite 5, Tifton, GA 31794-1698 | 2012-04-30 |
| 1225354525 | Flavia S Rossi | Pediatrics | 39 Kent Rd, Suite 5, Tifton, GA 31794-1698 | 2010-04-12 |
| 1073849337 | Noreen Mian | Pediatrics | 901 18th St E, Tifton, GA 31794-3648 | 2009-10-21 |
| 1801015367 | Dixie Dawn Griffin | Pediatrics | 39 Kent Rd, Suite 5, Tifton, GA 31794-1698 | 2007-04-24 |
| Find all providers in TIFTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.