George Dean Wilson Jr., M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD011166 Issued in TN

Practice address

105 Woodlawn Drive
Johnson City, TN 37602-5978

Phone

(423) 928-6174

Fax

(423) 926-2258

NPI assigned

May 23, 2006

Last updated

Mar 3, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tri State Mountain Neurology Associates PC

  • Neurology Physician
  • Johnson City, TN
  • NPI 1801823638
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236038400000",
    "number": "1437104114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3908 MARABLE LANE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37601",
            "telephone_number": "423-283-4677",
            "fax_number": "423-283-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WOODLAWN DRIVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376025978",
            "telephone_number": "423-928-6174",
            "fax_number": "423-926-2258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GEORGE",
        "middle_name": "DEAN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TN",
            "license": "MD011166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1292658",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0118991",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3168835",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP CARITEN",
            "identifier": "602005579",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7906816",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0140000775",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP GROUP ID",
            "identifier": "164888600",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6196853",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64796980",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "A55508",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "130014480",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wilson Pharmacy, Inc. (Wilson Pharmacy Wellness)
• Alexandria R Wilson, FNP
• Annie Grace Wilson, MS, BCBA, LBA
• Craig Robert Wilson, BS
• Frances Wilson
• Guy B Wilson Jr., D.PH
• Helen Heeyoung Wilson, MD
• James Douglas Wilson, LCSW
• James Marion Wilson, M.D.
• Jeanne Wilson, M.A., CCC-SLP

• Neurology Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Neurology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.