Provider Demographics
NPI:1073217428
Name:WILSON, NERMENE GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:NERMENE
Middle Name:GEORGE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16000 JOHNSTON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7664
Mailing Address - Country:US
Mailing Address - Phone:714-326-6001
Mailing Address - Fax:
Practice Address - Street 1:PRIMARY CARE CENTER
Practice Address - Street 2:613 CAMPUS DRIVE SUITE #200
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-0881
Practice Address - Country:US
Practice Address - Phone:714-326-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116038445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine