MEDICARE: AMBER WILSON-TATE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1194418921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER WILSON-TATE

Provider Business Mailing Address
First Line	:	284 LINKS CROSSING DR
Second Line	:
City	:	BLYTHEWOOD
State	:	SC
Zip	:	29016-7620
Country	:	US
Telephone Number	:	803-464-4729
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 MYRTLE BEACH HWY
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29153-5033
Country	:	US
Telephone Number	:	803-464-4729
Fax Number	:

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

Provider Enumeration Date	:	05/29/2023
Last Update Date	:	11/21/2023

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Directions to “ AMBER WILSON-TATE ” Practice Location

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