Individual
MR. JOHN ROGER WILSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6122
(864) 560-6276
Mailing address
PO BOX 651602, CHARLOTTE, NC 28265-1602
(864) 560-4123
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3102
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1653
—
SC
01
—
P00708588
RR MEDICARE
SC
Enumeration date
10/27/2006
Last updated
07/02/2009
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