Provider Demographics
NPI:1790753002
Name:WADLEY, RODNEY CHARLES SR (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:CHARLES
Last Name:WADLEY
Suffix:SR
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 1:470 HULON LANE
Mailing Address - Street 2:ATTN: VP - REVENUE CYCLE
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-358-6100
Mailing Address - Fax:803-358-6105
Practice Address - Street 1:811 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-358-6100
Practice Address - Fax:803-358-6105
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0553252083X0100X
SC832682083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055325OtherPHYSICIAN LICENSE