MEDICARE: DR. JAMES M WILSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	17962	SC
2	174400000X	Specialist	01456	NC
3	207RR0500X	Rheumatology Physician	MD17962	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	88169	OTHER	NC	BLUE CROSS BLUE SHIELD
3	1184627317	OTHER	SC	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184627317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M WILSON M.D.

Provider Business Mailing Address
First Line	:	744 ARDEN LN
Second Line	:	SUITE 225
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2984
Country	:	US
Telephone Number	:	803-329-1660
Fax Number	:	803-329-4118

Provider Business Practice Location Address
First Line	:	744 ARDEN LN
Second Line	:	SUITE 225
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2984
Country	:	US
Telephone Number	:	803-329-1660
Fax Number	:	803-329-4118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/21/2020

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Directions to “ DR. JAMES M WILSON M.D.” Practice Location

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