Individual
JESSIE RUTH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 HEALTHY WAY STE 1200, ANDERSON, SC 29621-7916
(864) 512-6140
(864) 512-6149
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-6140
(864) 512-6149
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17060
SC
207X00000X
Orthopaedic Surgery Physician
Primary
17060
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T10538
—
SC
Enumeration date
08/04/2006
Last updated
11/23/2022
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