Provider Demographics
NPI:1770713133
Name:WILSON, JOSHUA (PA)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 SEA BISCUIT DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-5703
Mailing Address - Country:US
Mailing Address - Phone:704-221-1536
Mailing Address - Fax:
Practice Address - Street 1:1008 SEA BISCUIT DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5703
Practice Address - Country:US
Practice Address - Phone:704-221-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant