Provider Demographics
NPI:1144077538
Name:WILSON, SAMUEL TYLER
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:TYLER
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 TOBYLYNN DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5930
Mailing Address - Country:US
Mailing Address - Phone:931-982-0785
Mailing Address - Fax:
Practice Address - Street 1:8283 RIVER ROAD PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-6009
Practice Address - Country:US
Practice Address - Phone:866-395-6390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program