Provider Demographics
NPI:1689857781
Name:WILSON, THOMSD LAMAR
Entity Type:Individual
Prefix:MR
First Name:THOMSD
Middle Name:LAMAR
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BERRY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9620
Mailing Address - Country:US
Mailing Address - Phone:803-736-8436
Mailing Address - Fax:
Practice Address - Street 1:304 BERRY RIDGE CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9620
Practice Address - Country:US
Practice Address - Phone:803-736-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies