Individual
MR. JOHN WINKLE WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8002 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 347-7227
Mailing address
PO BOX 50760, MYRTLE BEACH, SC 29579-0013
(843) 234-5139
(843) 234-6822
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
3974
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039746
—
SC
05
—
GP4505
—
SC
Enumeration date
04/20/2006
Last updated
12/23/2010
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