Provider Demographics
NPI:1194418921
Name:WILSON-TATE, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WILSON-TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 LINKS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7620
Mailing Address - Country:US
Mailing Address - Phone:803-464-4729
Mailing Address - Fax:
Practice Address - Street 1:60 MYRTLE BEACH HWY
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29153-5033
Practice Address - Country:US
Practice Address - Phone:803-464-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health