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General NPI Number Information
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NPI Number | 1235287996
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Entity Type | Individual
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Provider Name | WILMONT GREGORY MARTIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 1818 REMOUNT RD
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City | CHARLESTON
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State | SC
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Zip | 29406-3239
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Country | US
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Telephone | 843-766-6308
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Fax | 866-533-4473
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Provider Business Mailing Address
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Address Line | 1871 SAVAGE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4726
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Country | US
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Telephone | 843-766-6308
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Fax | 843-804-9883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 57-011973
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License Number State | OH
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