Individual
JOAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2212 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 572-8921
(434) 572-2063
Mailing address
159 EXECUTIVE DR, STE E, DANVILLE, VA 24541-4160
(434) 572-8921
(434) 572-2063
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101034828
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006207561
—
VA
01
—
240940
BCBS
VA
01
—
48092
OPTIMA
VA
Enumeration date
03/14/2006
Last updated
02/17/2022
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