Wilson, Charles Derrick

Wilson, Charles Derrick is an individual health care provider with primary practice located at 4800 48Th St , Valley AL 36854-3666. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Wilson, Charles Derrick can be contacted via phone (334) 756-1848.

Contact Information

Primary practice address
4800 48Th St Valley AL 36854-3666
Phone: (334) 756-1848
Fax: (334) 756-1854
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 1-044011 Alabama
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RN065069 Georgia

Profile Details

NPI number 1730146309
LBN Legal business name Wilson, Charles Derrick
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 27th, 2006
Last updated Sep 27th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730146309 NPPES
Alabama Other 51517977 BCBSAL PROVIDER #
Alabama MEDICAID 000549381E BCBSAL PROVIDER #
Alabama MEDICAID 051517977 BCBSAL PROVIDER #
Alabama MEDICAID 000549381C BCBSAL PROVIDER #
Alabama MEDICAID 000549381D BCBSAL PROVIDER #

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