Active NPI
Jeremy Gordon Wilson
- Behavior Technician
- Concord, NC
National Provider Identifier
1154933364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 900 Branchview Dr NE
Concord, NC 28025-2213 - Phone
- (704) 780-4271
- Fax
- (704) 788-2016
- NPI assigned
- Aug 19, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
900 Branchview Dr NE
Concord, NC 28025-2213
Mailing address
10532 Haddington Dr NW
Charlotte, NC 28269-6956
Phone (954) 850-1125
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597795200000",
"number": "1154933364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10532 HADDINGTON DR NW",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282696956",
"telephone_number": "954-850-1125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 BRANCHVIEW DR NE",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252213",
"telephone_number": "704-780-4271",
"fax_number": "704-788-2016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JEREMY",
"middle_name": "GORDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-19",
"last_updated": "2020-08-19",
"certification_date": "2020-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.