Individual
DR. DAVID MARK WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 347-7144
(843) 347-7331
Mailing address
PO BOX 1599, CONWAY, SC 29528-1599
(843) 347-7144
(843) 347-7331
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
15323
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153238
—
SC
Enumeration date
08/26/2005
Last updated
09/07/2010
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