Provider Demographics
NPI:1790966737
Name:DR. ROBIN A. WILSON AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DR. ROBIN A. WILSON AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-963-9149
Mailing Address - Street 1:PO BOX 81055
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-0018
Mailing Address - Country:US
Mailing Address - Phone:864-963-9149
Mailing Address - Fax:864-967-4727
Practice Address - Street 1:205 NORTH MAPLE STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-963-9149
Practice Address - Fax:864-967-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0727207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty