Individual
LARRY LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14 DOCTORS CIR, SUITE 5, SUPPLY, NC 28462-4097
(910) 754-9166
(910) 754-2972
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 754-9166
(704) 754-2972
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
16506
SC
207V00000X
Obstetrics & Gynecology Physician
Primary
200601686
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
L10281
—
SC
Enumeration date
06/10/2005
Last updated
06/25/2010
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