Individual
MR. GREGORY CHARLES WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2280 HEMBY LN, GREENVILLE, NC 27834-3773
(252) 744-9400
(252) 744-9401
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
100505
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902085491
—
NC
01
—
19FUD
BCBS NC
NC
Enumeration date
10/31/2007
Last updated
06/25/2021
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