Individual
JAKE BARRETT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0100
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
88451
SC
207RG0100X
Gastroenterology Physician
Primary
V9999
TX
Other
Enumeration date
04/05/2019
Last updated
07/10/2026
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