Provider Demographics
NPI:1063586618
Name:GEORGE A. WILKINSON, MD PA
Entity type:Organization
Organization Name:GEORGE A. WILKINSON, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-652-8021
Mailing Address - Street 1:150 WINDING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-5649
Mailing Address - Country:US
Mailing Address - Phone:843-652-8021
Mailing Address - Fax:
Practice Address - Street 1:4033 HWY 17 BYPASS
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5032
Practice Address - Country:US
Practice Address - Phone:843-652-8021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21654261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4635Medicaid
SCH174208592Medicare PIN
SC8592Medicare PIN