Individual
JAMES JONTHAN ROBERT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 PALMETTO PARK CIR, COLUMBIA, SC 29229-7017
(803) 445-7586
Mailing address
1301 TAYLOR ST, COLUMBIA, SC 29201-2942
(803) 445-7586
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
2418AJWCOR18
SC
Other
Enumeration date
03/31/2026
Last updated
03/31/2026
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