Healthcare Provider Details

I. General information

NPI: 1942959499
Provider Name (Legal Business Name): COLIN WILSON WOOLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-4403
  • Fax:
Mailing address:
  • Phone: 843-692-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number98085
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: