Wilkins Dedwylder, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

08328 Issued in MS

Practice address

1017 Jackson Ave
Leakesville, MS 39451-9105

Phone

(601) 394-4135

Fax

(601) 394-4455

NPI assigned

Jan 30, 2007

Last updated

Feb 16, 2012By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Edward Kofi Lartevi MD PMC

  • Emergency Medicine Physician
  • Cleveland, MS
  • NPI 1891968327
  NPD (past)
• Emcare Physician Providers, Inc.

  • Emergency Medicine Physician
  • Cleveland, MS
  • NPI 1366491102
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1871630186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 PAULDING RD",
            "city": "LEAKESVILLE",
            "state": "MS",
            "postal_code": "394513055",
            "telephone_number": "601-394-2975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 JACKSON AVE",
            "city": "LEAKESVILLE",
            "state": "MS",
            "postal_code": "394519105",
            "telephone_number": "601-394-4135",
            "fax_number": "601-394-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDWYLDER",
        "first_name": "WILKINS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "08328",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "08328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01658391",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coastal Family Health Center, Inc
• Contona Collins, IDD WAIVER SERVICES
• Michael Stacy Cook, D.M.D.
• Cradle to the Grave Healthcare LLC
• Amber Davis, PCCSS
• Delco Inc Dba Brookwood Manor Nursing Center
• Cynthia W Denmark, FNP
• Noah Dickens
• Diona Dickerson, CCSS
• Dobbins Family Pharmacy LLC

• Family Medicine Physician in Leakesville, MS
• Providers in Leakesville, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; 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.