LARRY LEE WILSON (NPI# 1356345094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356345094 |
| Entity Type | Individual |
| Full Name | LARRY LEE WILSON |
| Credential | MD |
| Practice Address |
14 Doctors Cir Suite 5 Supply NC 28462-4097 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 9107549166 |
| Practice Fax Number | 9107542972 |
| Mailing Telephone | 7047549166 |
| Mailing Fax Number | 7047542972 |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2010-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 200601686 | NC | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 16506 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | L10281 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750869285 | Larry Colenzo Wilson | Counselor | 6224 N Inwood Rd, Shreveport, LA 71119-7213 | 2018-08-06 |
| 1992171086 | Larry Wilson | Chiropractor | 800 W Platt St Ste 2, Tampa, FL 33606-4112 | 2015-08-12 |
| 1528211232 | Larry James Wilson | Social Worker | 1572 Zephyr Ave, El Cajon, CA 92021-3560 | 2008-10-25 |
| 1538344908 | Larry Dwight Wilson Jr. | Counselor | 3020 18th St Suite 17, Catholic Charities, Columbus, NE 68601-4254 | 2008-01-04 |
| 1689749582 | Larry Flick Wilson | Preventive Medicine | Faa, Ace-300, 901 Locust Street, Rm 350, Kansas City, MO 64106 | 2006-11-24 |
| 1932297892 | Larry Don Wilson | Dentist | 2247 Helton Dr, Florence, AL 35630-1063 | 2006-10-10 |
| 1275541344 | Larry Bertram Wilson | Dentist | 721 W Arapaho Rd, #102, Richardson, TX 75080-4155 | 2006-08-04 |
| 1801819495 | Larry Al Wilson | Counselor | 2708 E Tanager Trl, Orange, TX 77632-0750 | 2006-07-25 |
| 1134121221 | Larry T Wilson | Family Medicine | 701 S Morgan Ave, Andrews, SC 29510 | 2005-06-02 |
| 1063918167 | Larry Wilson | Case Manager/Care Coordinator | 418 Center St, Wheelersburg, OH 45694-1712 | 2018-04-05 |
| Street Address |
14 DOCTORS CIR SUITE 5 |
| City | SUPPLY |
| State | NC |
| Zip Code | 28462-4097 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093719726 | Susan Kady Wilson | Obstetrics & Gynecology | 14 Doctors Cir, Suite 5, Supply, NC 28462-4097 | 2005-06-10 |
| 1255765095 | Mary Beth Koehler | Nurse Practitioner | 14 Doctors Cir, Suite 3, Supply, NC 28462-4097 | 2013-08-28 |
| 1346594504 | Instride Foot and Ankle Specialists, Pllc | Podiatrist | 14 Doctors Cir, Suite 2, Supply, NC 28462-4097 | 2012-11-08 |
| 1669647111 | Cataract Consultants Pa | Ophthalmology | 14 Doctors Cir, Suite 1, Supply, NC 28462-4097 | 2008-04-25 |
| 1396874285 | Brunswick Foot & Ankle Surgery | Podiatrist | 14 Doctors Cir, Suite 2, Supply, NC 28462-4097 | 2007-03-05 |
| 1750420428 | Shore Fun Pediatrics | Pediatrics | 14 Doctors Cir, Suite 3, Supply, NC 28462-4097 | 2007-02-06 |
| 1134131584 | Alicia Hope Tyndall | Nurse Practitioner | 14 Doctors Cir, Suite 3, Supply, NC 28462-4097 | 2006-08-13 |
| 1790797108 | Joanne Peck | Pediatrics | 14 Doctors Cir, Suite 3, Supply, NC 28462-4097 | 2006-08-13 |
| 1467425348 | Joseph F Kibler | Podiatrist | 14 Doctors Cir, Suite 2, Supply, NC 28462-4088 | 2006-02-09 |
| 1528058963 | North Carolina Physician Network, Inc. | Obstetrics & Gynecology | 14 Doctors Cir, Suite 5, Supply, NC 28462-4088 | 2005-10-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558910943 | Lisa M Jock | Technician | 1276 Skipper Run Sw, Supply, NC 28462 | 2019-09-09 |
| 1023532686 | Novant Health Brunswick Endoscopy Center, LLC | Nurse Anesthetist, Certified Registered | 13 Medical Campus Drive, Suite 101, Supply, NC 28462 | 2017-07-26 |
| 1821510579 | Novant Health Brunswick Endoscopy Center, LLC | Clinic/Center | 13 Medical Campus Dr, Suite 101, Supply, NC 28462 | 2017-07-14 |
| 1831461920 | Reginald Lofton Hewett | Counselor | 1473 Cedar Grove Rd, Supply, NC 28462 | 2012-02-03 |
| 1760793343 | Coastal Hearing Centers, Inc | Clinic/Center | 2298 Ocean Hwy, Supply, NC 28462 | 2010-06-29 |
| 1083943567 | Lorell Sneeden Pait | Nurse Practitioner | 795 Ocean Highway West, Supply, NC 28462 | 2009-12-14 |
| 1043451321 | Well Care Home Care | Home Health | 118 Ocean Highway West, Supply, NC 28462 | 2009-03-16 |
| 1467672873 | South Atlantic Radiation Oncology, LLC | Clinic/Center | 545 Ocean Highway West, Supply, NC 28462 | 2007-04-26 |
| 1225177702 | Barbara C Bauer | Counselor | 1041 Old Ocean Highway, Supply, NC 28462 | 2007-02-05 |
| 1891852323 | Liberty Medical Specialties, Inc | Durable Medical Equipment & Medical Supplies | 1120 Ocean Hwy West, Supply, NC 28462 | 2007-01-03 |
| Find all providers in zip 28462 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629185905 | Brunswick Ob-gyn, P.a. | Obstetrics & Gynecology | 116 Durham St Ste 205, Supply, NC 28462-1909 | 2006-08-24 |
| 1093719726 | Susan Kady Wilson | Obstetrics & Gynecology | 14 Doctors Cir, Suite 5, Supply, NC 28462-4097 | 2005-06-10 |
| 1790892081 | Diane Nicole Ballerino-regan | Obstetrics & Gynecology | 20 Medical Campus Dr, Suite 205, Supply, NC 28462-4096 | 2006-08-24 |
| 1528058963 | North Carolina Physician Network, Inc. | Obstetrics & Gynecology | 14 Doctors Cir, Suite 5, Supply, NC 28462-4088 | 2005-10-26 |
| 1861487332 | Robert E Hassler | Obstetrics & Gynecology | 14 Doctors Cir, Suite 5, Supply, NC 28462-4097 | 2005-09-12 |
| 1902890874 | Lindian J Swaim Jr. | Obstetrics & Gynecology | 14 Doctors Cir, Suite 5, Supply, NC 28462-4097 | 2005-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336755057 | Holly Springs Ob/gyn, P.a. | Obstetrics & Gynecology | 104 Conway Ct, Cary, NC 27513-9400 | 2020-09-17 |
| 1184244881 | Carolinas Physicians Network Inc | Obstetrics & Gynecology | 150 Professional Park Dr Ste 200, Mooresville, NC 28117-5604 | 2020-04-22 |
| 1154940294 | Atrium Health North Market Network LLC | Obstetrics & Gynecology | 294 N Nc 16 Business Hwy, Denver, NC 28037-8011 | 2020-04-09 |
| 1649899782 | Atrium Health North Market Network LLC | Obstetrics & Gynecology | 101 E Wt Harris Blvd Ste 5002, Charlotte, NC 28262-3588 | 2020-04-09 |
| 1528617362 | Arboretum Obstetrics & Gynecology | Obstetrics & Gynecology | 3125 Springbank Ln Ste B, Charlotte, NC 28226-3379 | 2019-09-04 |
| 1346895489 | Benjamin Chi | Obstetrics & Gynecology | 111 Mason Farm Rd # 4300b, Chapel Hill, NC 27599-6136 | 2019-08-06 |
| 1265903256 | Albemarle Physician Services - Sentara, Inc | Obstetrics & Gynecology | 701 Luke St Ste D, Edenton, NC 27932-9680 | 2018-12-17 |
| 1396212080 | Fatima Sayyeda Ahmed | Obstetrics & Gynecology | 4904 Majestic Prince Ct, Raleigh, NC 27606-4269 | 2018-10-31 |
| 1174016711 | Moses Cone Physician Services, Inc. | Obstetrics & Gynecology | 520 Maple Ave Ste C, Reidsville, NC 27320-4600 | 2018-06-08 |
| 1467975672 | James Louis Price IIi | Obstetrics & Gynecology | 7830 Masonboro Sound Rd, Wilmington, NC 28409-2671 | 2017-07-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.