Provider Demographics
NPI:1922301589
Name:WILSON, EUGENE KENNON III (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KENNON
Last Name:WILSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 896206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6206
Mailing Address - Country:US
Mailing Address - Phone:252-447-7088
Mailing Address - Fax:252-447-2752
Practice Address - Street 1:532 WEBB BLVD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2042
Practice Address - Country:US
Practice Address - Phone:252-447-7088
Practice Address - Fax:252-447-2752
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235535207Q00000X
NC2014-02270208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine