Individual
SUSAN KADY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14 DOCTORS CIR, SUITE 5, SUPPLY, NC 28462-4097
(910) 754-9166
(910) 754-2972
Mailing address
1900 RANDOLPH RD, SUITE 500, CHARLOTTE, NC 28207-1122
(704) 384-9113
(704) 316-0508
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
19107
SC
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T30464
—
SC
Enumeration date
06/10/2005
Last updated
07/08/2007
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