=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275706889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILKERSON OBSTETRICS & GYNECOLOGY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2008
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4414 LAKE BOONE TRL SUITE 210
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-7513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-571-1040
-----------------------------------------------------
Fax | 919-781-0247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4414 LAKE BOONE TRL SUITE 210
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-7513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-571-1040
-----------------------------------------------------
Fax | 919-781-0247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEAN W. CARTER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 919-571-1040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------