Individual
CHARLES CLINTON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2025 E MAIN ST, SUITE 7, RICHMOND, VA 23223-7069
(804) 591-2890
(804) 591-2896
Mailing address
11001 BRIARLYNN CT, FAIRFAX STATION, VA 22039-2331
(703) 425-5352
(703) 425-0842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101058559
VA
207Q00000X
Family Medicine Physician
G22781
CA
Other
Enumeration date
01/31/2007
Last updated
07/15/2009
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