Individual
DR. TIMOTHY WENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1190 FILBERT HWY STE 110, YORK, SC 29745-9324
(803) 628-0004
(803) 628-6004
Mailing address
PO BOX 532664, ATLANTA, GA 30353-2664
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
27103
NC
207Q00000X
Family Medicine Physician
27103
NC
207R00000X
Internal Medicine Physician
Primary
14742
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12947
BLUE CROSS
NC
05
—
147424
—
SC
05
—
8912947
—
NC
01
—
P00125486
RAILROAD MEDICARE
NC
Enumeration date
05/16/2006
Last updated
10/07/2024
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