| Dana L. Wiley, Md Pa | |
|
102 Commons Blvd Suite C Piedmont SC 29673-7766 | |
| (864) 220-9115 | |
| (864) 220-9513 |
| Full Name | Dana L. Wiley, Md Pa |
|---|---|
| Speciality | Counselor |
| Location | 102 Commons Blvd, Piedmont, South Carolina |
| Authorized Official Name and Position | Dana Lee Wiley (PRESIDENT) |
| Authorized Official Contact | 8642209115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dana L. Wiley, Md Pa 102 Commons Blvd Suite C Piedmont SC 29673-7766 Ph: (864) 220-9115 | Dana L. Wiley, Md Pa 102 Commons Blvd Suite C Piedmont SC 29673-7766 Ph: (864) 220-9115 |
| NPI Number | 1649293085 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 10/11/2007 |
| Medicare PECOS PAC ID | 9436190659 |
|---|---|
| Medicare Enrollment ID | O20050518000804 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649293085 | NPI | - | NPPES |
| GP4113 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 17523 (South Carolina) | Primary |
| Provider Name | Dana Wiley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427006808 PECOS PAC ID: 5799726923 Enrollment ID: I20050519000056 |
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