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NPI Code Detail

MEDICARE: DR. FRED HENRY WILSON MD

MEDICARE: DR. FRED HENRY WILSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician29994NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00823578OTHERNCRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548344450
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FRED HENRY WILSON MD
Provider Business Mailing Address
First Line : 1701 WESTCHESTER DR
Second Line : STE 850
City : HIGH POINT
State : NC
Zip : 27262-7254
Country : US
Telephone Number : 336-802-2000
Fax Number : 336-802-2534
Provider Business Practice Location Address
First Line : 4431 HWY 220 N
Second Line :
City : SUMMERFIELD
State : NC
Zip : 27358-9411
Country : US
Telephone Number : 336-643-7711
Fax Number : 336-643-3047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/12/2010

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