Provider Demographics
NPI:1427006808
Name:WILEY, DANA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LEE
Last Name:WILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300D NORTH MAIN STREET
Mailing Address - Street 2:STE 171 PMB
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-220-9115
Mailing Address - Fax:864-220-9513
Practice Address - Street 1:102 COMMONS BLVD
Practice Address - Street 2:STE C
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673
Practice Address - Country:US
Practice Address - Phone:864-220-9115
Practice Address - Fax:864-220-9513
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU66012084P0800X
PAMD4817092084P0800X
SC175232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC175232Medicaid
SCQ27602Medicare UPIN
SC175232Medicaid