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1208 Waverly Rd Nw Wilson NC 27896-1454 | |
| (252) 204-1381 | |
| (252) 598-0051 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1208 Waverly Rd Nw, Wilson, North Carolina |
| Authorized Official Name and Position | Cornelius Williams (PRESIDENTREGISTERED AGENT) |
| Authorized Official Contact | 2522041381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2002 Henderson NC 27536-2002 Ph: (252) 204-1381 | 1208 Waverly Rd Nw Wilson NC 27896-1454 Ph: (252) 204-1381 |
| NPI Number | 1376691519 |
|---|---|
| Provider Enumeration Date | 01/06/2007 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376691519 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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