Charles Clinton Wilson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101058559 Issued in VA

Practice address

2025 E Main St
Suite 7
Richmond, VA 23223-7069

Phone

(804) 591-2890

Fax

(804) 591-2896

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247616000000",
    "number": "1992842736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 BRIARLYNN CT",
            "city": "FAIRFAX STATION",
            "state": "VA",
            "postal_code": "220392331",
            "telephone_number": "703-425-5352",
            "fax_number": "703-425-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 E MAIN ST",
            "address_2": "SUITE 7",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232237069",
            "telephone_number": "804-591-2890",
            "fax_number": "804-591-2896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHARLES",
        "middle_name": "CLINTON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2009-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101058559",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G22781",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill S Wilons, LCSW
• Karasa A Wilson-Scott, AU.D.
• April L. Wilson
• Caitlin Rose Wilson
• Cassidy Land Wilson, OTR/L
• Cristi S. Wilson, M.D.
• Domonique Ashleigh-Nicole Wilson, LPC
• Drew Wilson
• Elizabeth M. Wilson
• Emily N. Wilson, MD

• Family Medicine Physician in Richmond, VA
• Providers in Richmond, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; 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.