Provider Demographics
NPI:1194870865
Name:WHITSON, PETER WOOD (MS)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:WOOD
Last Name:WHITSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GATEWAY CORPORATE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9740
Mailing Address - Country:US
Mailing Address - Phone:803-509-7200
Mailing Address - Fax:803-509-7213
Practice Address - Street 1:114 GATEWAY CORPORATE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9740
Practice Address - Country:US
Practice Address - Phone:803-509-7200
Practice Address - Fax:803-509-7213
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3436231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0665Medicaid