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Individual

DR. WILLIAM RANDOLPH WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
207 THREE BRIDGES RD, GREENVILLE, SC 29611-7549
(864) 220-1110
(864) 220-1104
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8803

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11947
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11947
SC LICENSE
SC
05
119473
SC
Enumeration date
03/15/2006
Last updated
06/23/2021
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