MEDICARE: THE WILSON AFFECT

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	111N00000X	Chiropractor
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1902619315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WILSON AFFECT

Provider Business Mailing Address
First Line	:	1014 TURTLE STONE RD
Second Line	:
City	:	BLYTHEWOOD
State	:	SC
Zip	:	29016-9267
Country	:	US
Telephone Number	:	205-526-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 LAKE CAROLINA WAY STE 280
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7563
Country	:	US
Telephone Number	:	205-526-6060
Fax Number	:

Authorized Official
Title or Position	:	ONWER
Name	:	TANIEKA TA'SHA WILSON-MYERS
Credential	:
Telephone Number	:	205-526-6060

Provider Enumeration Date	:	01/29/2025
Last Update Date	:	01/29/2025

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Directions to “THE WILSON AFFECT ” Practice Location

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