Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 2491 | SC |
NPI | 1306850193 |
---|---|
Provider Name | Dr. Thomas Cameron Wills |
First Address | N Charleston, SC 29420-7436 |
Second Address | N Charleston, SC 29420-7328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH2491 GCH462 | (05) | SC |
U83439 | (02) | SC |