Provider Demographics
NPI:1043521503
Name:WILSON, RACHEL CLICK (DO)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CLICK
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:701 MORGANTON SQUARE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4796
Practice Address - Country:US
Practice Address - Phone:865-982-7101
Practice Address - Fax:833-908-2132
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVA695BMedicare PIN