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General NPI Number Information
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NPI Number | 1790966737
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Entity Type | Organization
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Legal Business Name | DR. ROBIN A. WILSON AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 205 NORTH MAPLE STREET SUITE 8
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City | SIMPSONVILLE
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State | SC
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Zip | 29681
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Country | US
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Telephone | 864-963-9149
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Fax | 864-967-4727
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Provider Business Mailing Address
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Address Line | PO BOX 81055
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-0018
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Country | US
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Telephone | 864-963-9149
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Fax | 864-967-4727
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROBIN A WILSON
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Credential | D.O.
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Telephone | 864-963-9149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0727
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License Number State | SC
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