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Individual

ALLEN WYLIE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
101 E WOOD ST STE 401, SPARTANBURG, SC 29303
(864) 560-6654
(864) 560-7388
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
38891
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
388912
SC
01
SCA8545019
MEDICARE PIN
SC
01
SCA8549068
MEDICARE PIN
SC
Enumeration date
06/13/2014
Last updated
01/20/2021
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