Healthcare Provider Details

I. General information

NPI: 1225974983
Provider Name (Legal Business Name): JULIE P WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 AIRPORT RD STE 7-104
ARDEN NC
28704-6402
US

IV. Provider business mailing address

229 AIRPORT RD STE 7-104
ARDEN NC
28704-6402
US

V. Phone/Fax

Practice location:
  • Phone: 828-474-0828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number170887
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: