Healthcare Provider Details

I. General information

NPI: 1558763466
Provider Name (Legal Business Name): SARA PENNINGTON WILSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 HENRY TECKLENBURG DR STE 310
CHARLESTON SC
29414-7713
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-266-5500
  • Fax: 843-606-8007
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number82303
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: