Organization
ENT AND FACE
Active
Other names
ENT and Face
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN CLAUD WILSON M.D. (OWNER)
(803) 366-9000
Entity
Organization
Contact information
Practice address
197 S HERLONG AVE, ROCK HILL, SC 29732-3427
(803) 366-9000
(803) 366-9200
Mailing address
197 S HERLONG AVE, ROCK HILL, SC 29732-3427
(803) 366-9000
(803) 366-9200
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
15101
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151016
—
SC
01
—
1669473237
NPI# INDIVIDUAL PROVIDER
—
Enumeration date
12/11/2006
Last updated
02/07/2014
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