Individual
CLARENCE WILLIAM WIMBERLY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
435 N CEDAR ST, SUMMERVILLE, SC 29483-6407
(843) 873-1592
(843) 871-2936
Mailing address
201 SIGMA DRIVE, SUITE 100, SUMMERVILLE, SC 29486-7722
(843) 873-1592
(843) 871-2936
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5740
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057404
—
SC
01
—
P01396493
RR MEDICARE
SC
Enumeration date
11/04/2005
Last updated
04/17/2019
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