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General NPI Number Information
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NPI Number | 1932371051
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Entity Type | Organization
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Legal Business Name | SANFORD PSYCHIATRIC GROUP, PA
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 115 CARBONTON RD
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City | SANFORD
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State | NC
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Zip | 27330-4008
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Country | US
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Telephone | 919-776-9522
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Fax | 919-776-9813
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Provider Business Mailing Address
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Address Line | 115 CARBONTON RD
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City | SANFORD
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State | NC
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Zip | 27330-4008
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Country | US
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Telephone | 919-776-9522
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Fax | 919-776-9813
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. THOMAS A WILSON
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Credential | M.D.
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Telephone | 919-776-9522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 19427
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License Number State | NC
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