Organization
WILSON PEDIATRICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BEVERLEY DELORIS WILSON M.D. (PRESIDENT)
(803) 536-6000
Entity
Organization
Contact information
Practice address
1615 MIDDLETON STREET, ORANGEBURG, SC 29118-4885
(803) 536-6000
Mailing address
P.O. BOX 2865, 1615 MIDDLETON STREET, ORANGEBURG, SC 29118-4885
(803) 536-6000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
16075
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160756
—
SC
Enumeration date
11/08/2006
Last updated
08/06/2012
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