Active NPI
Demetirus Legail Wilson
- Home Health Aide
- Ringgold, GA
National Provider Identifier
1699250225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- 066777
- Practice address
- 73 Mallard HL
Ringgold, GA 30736-4964 - Phone
- (423) 503-4507
- NPI assigned
- Sep 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 066777 | TN | Primary |
Addresses
Primary practice location
73 Mallard HL
Ringgold, GA 30736-4964
Mailing address
3584 Bennett Rd
East Ridge, TN 37412-1167
Phone (423) 635-8738
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 474763392 | Other | TN | CITY OF CHATTANOOGA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 066777 | TN | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727740800000",
"number": "1699250225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3584 BENNETT RD",
"city": "EAST RIDGE",
"state": "TN",
"postal_code": "374121167",
"telephone_number": "423-635-8738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "73 MALLARD HL",
"city": "RINGGOLD",
"state": "GA",
"postal_code": "307364964",
"telephone_number": "423-503-4507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DEMETIRUS",
"middle_name": "LEGAIL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-28",
"last_updated": "2024-10-01",
"certification_date": "2024-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Home Health Aide",
"state": "TN",
"license": "066777",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CITY OF CHATTANOOGA",
"identifier": "474763392",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ringgold, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.