Individual
PETER DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-9707
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MPA.3364
SC
Other
Enumeration date
09/25/2019
Last updated
12/02/2019
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