Individual
JESSICA LEIGH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8 RICHLAND MEDICAL PARK DR STE 400, COLUMBIA, SC 29203
(803) 765-0871
(803) 765-9215
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3000
SC
363A00000X
Physician Assistant
PA9106699
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003127651B
—
GA
05
—
0065294-00
—
FL
05
—
3676PA
—
SC
Enumeration date
09/13/2012
Last updated
03/19/2019
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