Provider Demographics
NPI:1134109085
Name:WILKINS, THOMAS LAWSON (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LAWSON
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:202 NORTH MAIN STREET
Mailing Address - City:MT GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306
Mailing Address - Country:US
Mailing Address - Phone:910-439-1573
Mailing Address - Fax:910-439-1773
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:NC
Practice Address - Zip Code:27306-9250
Practice Address - Country:US
Practice Address - Phone:910-439-1573
Practice Address - Fax:910-439-1773
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P78493Medicare UPIN
NC2756949DMedicare PIN