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General NPI Number Information
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NPI Number | 1942620257
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Entity Type | Individual
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Provider Name | ALEX MARY LOGAN WILSON DO
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Gender | Female
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 233 LONGTOWN RD
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City | COLUMBIA
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State | SC
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Zip | 29229-8550
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Country | US
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Telephone | 803-865-2122
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Fax | 803-865-1464
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Provider Business Mailing Address
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Address Line | PO BOX 6069
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City | WEST COLUMBIA
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State | SC
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Zip | 29171-6069
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Country | US
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Telephone | 803-865-2122
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Fax | 803-865-1464
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 90103
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 201047
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License Number State | NC
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