David  R  Wilson    MD
Contract Details
BHC Oneonta
Facility name
Provider ID
P000001883
NPI
1982795761
Tax ID
631094807
Effective Date
1/1/1996
Last Updated
2/4/2015
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
85.00
Location Details
Address
150 Gilbreath Drive Suite 201
Oneonta, AL 35121
United States
County
Blount
Phone
2052748198 (Phone)
Billing Details
Address
P.O. Box 830605
Birmingham, AL 35283
Billing Phone
2052748198
Specialty Type
Family Practice
Map
Address