# WILSON PEDIATRICS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659440915
- **Authorized official:** DR. BEVERLEY DELORIS WILSON M.D. (PRESIDENT)
- **Authorized official phone:** (803) 536-6000

## Contact information

- **Practice address:** 1615 MIDDLETON STREET, ORANGEBURG, SC 29118-4885
- **Practice address phone:** (803) 536-6000
- **Mailing address:** P.O. BOX 2865, 1615 MIDDLETON STREET, ORANGEBURG, SC 29118-4885
- **Mailing address phone:** (803) 536-6000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 16075 | SC | Yes |

## Other

- **Enumeration date:** 11/08/2006
- **Last updated:** 08/06/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 160756 | — | SC |