Provider Demographics
NPI:1275529976
Name:WILSON, JAMES KIRK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KIRK
Last Name:WILSON
Suffix:
Gender:M
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:PO BOX 4174
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4174
Mailing Address - Country:US
Mailing Address - Phone:336-683-5284
Mailing Address - Fax:336-683-5279
Practice Address - Street 1:364 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5434
Practice Address - Country:US
Practice Address - Phone:336-683-5284
Practice Address - Fax:336-683-5279
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90171207L00000X
TXG8513207L00000X
GA032679207L00000X
NC200001633207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912719Medicaid
NC12719OtherBCBS
D80492Medicare UPIN
NC2282400AMedicare PIN