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General NPI Number Information
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NPI Number | 1093719726
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Entity Type | Individual
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Provider Name | SUSAN KADY WILSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14 DOCTORS CIR SUITE 5
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City | SUPPLY
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State | NC
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Zip | 28462-4097
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Country | US
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Telephone | 910-754-9166
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Fax | 910-754-2972
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Provider Business Mailing Address
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Address Line | 1900 RANDOLPH RD SUITE 500
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City | CHARLOTTE
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State | NC
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Zip | 28207-1122
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Country | US
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Telephone | 704-384-9113
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Fax | 704-316-0508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 19107
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | NC
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