Michelle Nicholson-Wilson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

94-00955 Issued in NC

Practice address

610 E Dr Martin Luther King Jr Dr
Maxton, NC 28364-1800

Phone

(910) 844-5410

Fax

(910) 844-3290

NPI assigned

Aug 7, 2006

Last updated

Jun 21, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Michelle N. Wilson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Opportunities Industrialization Center, Inc

  dba Oic Family Medical Center LTC

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
  • NPI 1932923950
  NPD (past)
• Raleigh Durham Medical Group PA

  • Family Medicine Physician
  • Cary, NC
  • NPI 1295784874
  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277078400000",
    "number": "1114936069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE DRIVE",
            "address_2": "P O BOX 1659",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283721659",
            "telephone_number": "910-521-2900",
            "fax_number": "910-272-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E DR MARTIN LUTHER KING JR DR",
            "city": "MAXTON",
            "state": "NC",
            "postal_code": "283641800",
            "telephone_number": "910-844-5410",
            "fax_number": "910-844-3290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON-WILSON",
        "first_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2010-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "94-00955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7988330 89015A5",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "WILSON",
            "middle_name": "N.",
            "prefix": "MS.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Charles Wesley Mauney
• Maxton Rescue Squad, Inc
• Paul McDowell, LCAS-A
• Ellen Lestine McMillian, MSW PLCSW CSAC
• Mind on Demand LLC
• Eugene B Nor, MD
• On Da Go Transport,LLC
• Leyia Bullard Oxendine, PA
• Mariah Oxendine
• Pharmax, Inc. (Medicine Shoppe)

• Family Medicine Physician in Maxton, NC
• Providers in Maxton, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.