Provider Demographics
NPI:1376839316
Name:WILSON, AYANA MAIA (MD)
Entity Type:Individual
Prefix:
First Name:AYANA
Middle Name:MAIA
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 1:4535 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:757-513-8844
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK
Practice Address - Street 2:STE. 208 OB/GYN -
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-779-4928
Practice Address - Fax:803-434-4699
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-00631207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine