Individual
SUZANNE LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
205 PAGE ROAD, PINEHURST, NC 28374-8798
(910) 295-5511
(910) 295-5481
Mailing address
205 PAGE ROAD, PINEHURST, NC 28374-8798
(910) 295-5511
(910) 295-5481
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
01975
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0407048
EVERCARE PROVIDER #
NC
01
—
144NO
BCBS
NC
01
—
195533
MEDCOST
NC
05
—
5905677
—
NC
01
—
FH1100235
FIRSTCAROLINA
NC
01
—
N01975
SC MEDICAID
SC
Enumeration date
07/18/2006
Last updated
10/02/2024
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