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General NPI Number Information
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NPI Number | 1821068099
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Entity Type | Organization
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Legal Business Name | WILSON GASTROENTEROLOGY PA
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 2605 FOREST HILLS RD SW
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City | WILSON
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State | NC
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Zip | 27893-4448
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Country | US
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Telephone | 252-243-7977
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Fax | 252-399-0514
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Provider Business Mailing Address
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Address Line | PO BOX 7014
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City | WILSON
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State | NC
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Zip | 27895-7014
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Country | US
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Telephone | 252-243-7977
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Fax | 252-399-0514
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GAIL A HOOKS
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Credential |
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Telephone | 252-243-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16053
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License Number State | NC
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