Provider Demographics
NPI:1881653889
Name:GAY, WILTON CARLYLE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILTON
Middle Name:CARLYLE
Last Name:GAY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2450 EMERALD PLACE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-551-1066
Mailing Address - Fax:252-551-1067
Practice Address - Street 1:2450 EMERALD PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5784
Practice Address - Country:US
Practice Address - Phone:252-551-1066
Practice Address - Fax:252-551-1067
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2017-12-07
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Provider Licenses
StateLicense IDTaxonomies
NC27455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC83994Medicare UPIN