Individual
LISA MICHELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3762 DURHAM RD, SUITE B, ROXBORO, NC 27573-2741
(336) 322-1024
(336) 322-1022
Mailing address
PO BOX 561, ROXBORO, NC 27573-0561
(336) 322-1024
(336) 322-1022
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200201023
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5903537
—
NC
05
—
N0102A
—
SC
Enumeration date
04/14/2006
Last updated
08/12/2013
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