Provider Demographics
NPI:1679785422
Name:WILSON, BREEZY (MD)
Entity type:Individual
Prefix:
First Name:BREEZY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 GREENMOR DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-6445
Mailing Address - Country:US
Mailing Address - Phone:205-481-8530
Mailing Address - Fax:205-481-6543
Practice Address - Street 1:1179 GREENMOR DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6445
Practice Address - Country:US
Practice Address - Phone:205-481-8530
Practice Address - Fax:205-481-6543
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.28404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine