Malissa Gail Wilson, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

14482 Issued in SC

Practice address

1308 Laurel Street
Palmetto Senior Care Laurel
Columbia, SC 29201

Phone

(803) 931-8166

Fax

(803) 931-8183

NPI assigned

Jul 31, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Malissa Gail Kinard Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: mwilson385791@direct.ghs.myhfn.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073529053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 RICHLAND MEDICAL PARK",
            "address_2": "PALMETTO SENIOR CARE STE 203",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-434-3770",
            "fax_number": "803-434-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 LAUREL STREET",
            "address_2": "PALMETTO SENIOR CARE LAUREL",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29201",
            "telephone_number": "803-931-8166",
            "fax_number": "803-931-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MALISSA",
        "middle_name": "GAIL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "SC",
            "license": "14482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALISSA",
            "last_name": "KINARD",
            "middle_name": "GAIL",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• L. Britt Wilson, PHD
• La Tonya Wilson, MSN, FNP-BC, NP-C
• Leslie Wilson, MA, NCACII
• Lorna Katrina Wilson, OD
• Lynn L. Wilson, MD
• Mandy Wilson
• Mary Elizabeth Wilson
• Mary Jones Wilson, MPH
• Muhammad Wilson, SLP
• Octavia Roshea Wilson

• Geriatric Medicine (Internal Medicine) Physician in Columbia, SC
• Providers in Columbia, SC by specialty
• Geriatric Medicine (Internal Medicine) Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.