=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023042934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM WINGFIELD JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 06/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 SEVEN FARMS DRIVE SUITE 125
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-284-5300
-----------------------------------------------------
Fax | 843-284-5301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 WINGO WAY SUITE 102
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29464-2885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-388-2400
-----------------------------------------------------
Fax | 843-388-2444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | SC6129
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------