Provider Demographics
NPI:1902619315
Name:THE WILSON AFFECT
Entity type:Organization
Organization Name:THE WILSON AFFECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:TANIEKA
Authorized Official - Middle Name:TA'SHA
Authorized Official - Last Name:WILSON-MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-526-6060
Mailing Address - Street 1:1014 TURTLE STONE RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9267
Mailing Address - Country:US
Mailing Address - Phone:205-526-6060
Mailing Address - Fax:
Practice Address - Street 1:5 LAKE CAROLINA WAY STE 280
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7563
Practice Address - Country:US
Practice Address - Phone:205-526-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty