Provider Demographics
NPI:1063179836
Name:WILSON, CHARLES FORD II
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FORD
Last Name:WILSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GRANARY RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2534
Mailing Address - Country:US
Mailing Address - Phone:540-487-1911
Mailing Address - Fax:
Practice Address - Street 1:1027 RICHMOND AVE STE 107
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5087
Practice Address - Country:US
Practice Address - Phone:540-886-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002596237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist