Provider Demographics
NPI:1326029174
Name:WILSON, STANLEY CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:CLAYTON
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 1:409 PARKWAY DR
Mailing Address - Street 2:E
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 PARKWAY DR
Practice Address - Street 2:E
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1659
Practice Address - Country:US
Practice Address - Phone:336-273-2226
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0100072OtherUHC
NC4141147OtherAETNA
NC88455OtherBCBS
NC0100072OtherUHC
NCC80829Medicare UPIN