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General NPI Number Information
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NPI Number | 1730305681
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Entity Type | Individual
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Provider Name | ASHLEY SUZANNE WILSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 2700 COLTSGATE RD STE 101
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City | CHARLOTTE
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State | NC
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Zip | 28211-3573
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Country | US
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Telephone | 704-365-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 2046 SAGE PARK DR
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City | CHARLOTTE
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State | NC
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Zip | 28217-4546
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Country | US
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Telephone | 412-953-9390
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-01669
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License Number State | NC
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