Derek Alan Wilson

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

4160 Piedmont Pkwy Ste 207
Greensboro, NC 27410-8174

Phone

(336) 645-6733

NPI assigned

Jul 23, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sunrise ABA & Autism Services, L.L.C

  • Behavior Analyst
  • Greensboro, NC
  • NPI 1548811177
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1043829302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5202 OLDE FOREST DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274068763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 PIEDMONT PKWY STE 207",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274108174",
            "telephone_number": "336-645-6733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEREK",
        "middle_name": "ALAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-23",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myra Joy Wilson-Southerland, R.PH.
• Alysea Wilson
• Amelia Pugh Wilson, M.D.
• Christopher John Wilson, CRNA
• Christopher Whickcar Wilson, DC
• Derek Lee Wilson
• Ellen Cross Wilson, PH.D.
• Eric M Wilson, MD
• Jessica Aron Wilson, OTR/L
• Kadaisha Wilson

• Developmental Therapist in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Developmental Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.