| Doctor Name: | LARRY LEE WILSON |
| NPI Number: | 1356345094 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 16506 |
| Business Practice Address: | 14 Doctors Cir Suite 5 Supply, NC - 284624097 |
| Business Phone Number: | 9107549166 |
| Business Fax Number: | 9107542972 |
| Mailing Address: | Po Box 60447, CHARLOTTE |
| State: | NC |
| Postal Code: | 282600447 |
| Phone Number: | 7047549166 |
| Fax Number: | 7047542972 |
| NPI Enumeration Date: | 06/10/2005 |
| NPI Last Update Date: | 06/25/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 16506 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | 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. |