Individual
DERRICK DIONNE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W 5TH ST STE 800, WINSTON SALEM, NC 27101-3131
(800) 571-8308
Mailing address
500 W 5TH ST STE 800, WINSTON SALEM, NC 27101-3131
(800) 571-8308
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
302R000X
NC
Other
Enumeration date
05/03/2024
Last updated
05/03/2024
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