Healthcare Provider Details

I. General information

NPI: 1932785706
Provider Name (Legal Business Name): CHRISTOPHER THOMAS WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 RANDOLPH RD
CHARLOTTE NC
28207-1215
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2225
  • Fax: 704-323-3985
Mailing address:
  • Phone: 704-696-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2026-02850
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: