Healthcare Provider Details

I. General information

NPI: 1295763571
Provider Name (Legal Business Name): WILLIAM LINDSAY WYLIE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MILLS AVE
GREENVILLE SC
29605-4015
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-242-4840
  • Fax: 864-232-8113
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9847
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: