Provider Demographics
NPI:1013111590
Name:WILKINS, JOHN JASPER III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JASPER
Last Name:WILKINS
Suffix:III
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 1:800 JEFFERSON ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3710
Mailing Address - Country:US
Mailing Address - Phone:910-642-2642
Mailing Address - Fax:910-642-3346
Practice Address - Street 1:800 JEFFERSON ST
Practice Address - Street 2:SUITE 116
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3710
Practice Address - Country:US
Practice Address - Phone:910-642-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01069208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915599Medicaid