Basic Information
| Provider Information | |||||||||
| NPI: | 1154946424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 PHYSICIANS DRIVE SUITE A | ||||||||
| Address2: | |||||||||
| City: | GREER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647979150 | ||||||||
| FaxNumber: | 8647979155 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 PHYSICIANS DRIVE SUITE A | ||||||||
| Address2: | |||||||||
| City: | GREER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647979150 | ||||||||
| FaxNumber: | 8647979155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2020 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | LL84609 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.