MEDICARE: DR. WILLIAM EARL WILSON SR. MD

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	207Q00000X	Family Medicine Physician	8168	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00754343	OTHER	SC	RAILROAD MC ID- RSFPN

General Provider Information

NPI Number	:	1700872652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EARL WILSON SR. MD

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	1 BISHOP GADSDEN WAY STE 97
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3506
Country	:	US
Telephone Number	:	843-406-2362
Fax Number	:	843-606-8082

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/21/2022

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