Individual
MR. JACK KENNEY WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
637 S KERR AVE, WILMINGTON, NC 28403-8423
(910) 799-1810
(910) 452-2571
Mailing address
637 S KERR AVE, WILMINGTON, NC 28403-8423
(910) 799-1810
(910) 452-2571
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16755
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02701
BCBS NC
NC
05
—
8902701
—
NC
Enumeration date
07/12/2005
Last updated
09/20/2012
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