Individual
DR. DAIL WILSON LONGAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4614 PERRY CT, COLUMBIA, SC 29206-4516
(803) 782-4549
Mailing address
4614 PERRY CT, COLUMBIA, SC 29206-4516
(803) 782-4549
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4865
SC
Other
Enumeration date
09/21/2007
Last updated
09/21/2007
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