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Individual

SAMUEL MAYHEW WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1073 MEDICAL RIDGE RD, CLINTON, SC 29325-4542
(864) 833-3557
(864) 833-7724
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33377
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000663301
DE
01
020042401
RAILROAD MEDICARE
DE
05
333777
SC
Enumeration date
03/08/2006
Last updated
06/21/2023
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