MEDICARE: DR. WILTON CARLYLE GAY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	27455	NC

General Provider Information

NPI Number	:	1881653889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILTON CARLYLE GAY JR. MD

Provider Business Mailing Address
First Line	:	2450 EMERALD PLACE
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834
Country	:	US
Telephone Number	:	252-551-1066
Fax Number	:	252-551-1067

Provider Business Practice Location Address
First Line	:	2450 EMERALD PL
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5784
Country	:	US
Telephone Number	:	252-551-1066
Fax Number	:	252-551-1067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	12/07/2017

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