Individual
DR. MARK DAVID WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2728 SUNSET BLVD STE 201, WEST COLUMBIA, SC 29169-4837
(803) 254-1300
(803) 771-7597
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20467
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204674
—
SC
Enumeration date
04/14/2006
Last updated
01/11/2024
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