Active NPI
Susan Reese Wilson, LCSW
- Psychiatry Physician
- Birmingham, AL
National Provider Identifier
1316992431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 1805C
- Practice address
- 2868 Acton Road
Birmingham, AL 35243 - Phone
- (205) 968-8360
- Fax
- (205) 968-8373
- NPI assigned
- May 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 1805C | AL | Primary |
Addresses
Primary practice location
2868 Acton Road
Birmingham, AL 35243
Mailing address
956 Montclair Road
Suite 200
Birmingham, AL 35213
Phone (205) 949-4540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51531010 | Other | AL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316992431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "956 MONTCLAIR ROAD",
"address_2": "SUITE 200",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "35213",
"telephone_number": "205-949-4540",
"fax_number": "205-949-4541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2868 ACTON ROAD",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "35243",
"telephone_number": "205-968-8360",
"fax_number": "205-968-8373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SUSAN",
"middle_name": "REESE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AL",
"license": "1805C",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "51531010",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.