Provider Demographics
NPI:1801926969
Name:ANTHONY KINTE WILSON
Entity type:Organization
Organization Name:ANTHONY KINTE WILSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-327-6319
Mailing Address - Street 1:608 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1606
Mailing Address - Country:US
Mailing Address - Phone:919-327-6319
Mailing Address - Fax:
Practice Address - Street 1:608 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1606
Practice Address - Country:US
Practice Address - Phone:919-327-6319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare