Individual
DR. JERRY WILLIAM WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 GLENDALE DR SW, WILSON, NC 27893-4401
(252) 237-3141
(252) 293-8301
Mailing address
4700 WESTMINSTER DR, RALEIGH, NC 27604-6026
(919) 876-9036
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
21616
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13656
BCBS
NC
05
—
8913656
—
NC
Enumeration date
02/21/2007
Last updated
07/09/2007
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