Healthcare Provider Details

I. General information

NPI: 1770536971
Provider Name (Legal Business Name): CHRISTOPHER NELSON WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK STE 213
RALEIGH NC
27615-4731
US

IV. Provider business mailing address

PO BOX 96860
CHARLOTTE NC
28296-6860
US

V. Phone/Fax

Practice location:
  • Phone: 919-896-7066
  • Fax: 919-896-7067
Mailing address:
  • Phone: 919-896-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200401451
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: