Most Relevant Information
Provider Data
| NPI Number: | 1003302126 |
| Provider Name: | ANDREW WILSON |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/02/2018 |
| Last Updated: | 12/27/2021 |
Provider Practice Location
615 MCCALLIE AVE
CHATTANOOGA
TN
37403
Practice Location Phone/Fax
| Phone: | 4234254111 |
| Fax: |
Provider Mailing Location
975 E 3RD ST # 260
CHATTANOOGA
TN
374032173
Provider Mailing Phone/Fax
| Phone: | 4237789008 |
| Fax: |