Active NPI
Dennis Alonzo Wilson, M.D.
- Family Medicine Physician
- Greenville, SC
National Provider Identifier
1346221561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 15193
- Practice address
- 602 Airport Rd Ste C
Greenville, SC 29607-2617 - Phone
- (864) 234-7952
- Fax
- (864) 234-7985
- NPI assigned
- Nov 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 15193 | SC | |
| Family Medicine Physician | 207Q00000X | 15193 | SC | Primary |
Addresses
Primary practice location
602 Airport Rd Ste C
Greenville, SC 29607-2617
Mailing address
PO Box 23094
Columbia, SC 29224-3094
Phone (803) 846-3596
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 151925 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15193 | SC | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metro Treatment of South Carolina | Past | Accepting new patients | |
| Metro Treatment of South Carolina | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Methadone Clinic
- Greenville, SC
- NPI 1558576389
-
- Methadone Clinic
- West Columbia, SC
- NPI 1902012255
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675900800000",
"number": "1346221561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 23094",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292243094",
"telephone_number": "803-846-3596",
"fax_number": "803-736-7658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 AIRPORT RD STE C",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296072617",
"telephone_number": "864-234-7952",
"fax_number": "864-234-7985"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DENNIS",
"middle_name": "ALONZO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-07",
"last_updated": "2023-02-09",
"certification_date": "2023-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "SC",
"license": "15193",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "15193",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151925",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.