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CHARLIE ISIAH WILSON JR.
NPI 1538635115
Counselor - Professional in Conway, SC

Active since October 22, 2018PECOS Enrolled
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526(843) 347-5060(843) 347-3959 Get Directions Write a Review

NPPES record last updated: October 10, 2024. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Oct 10, 2024, Oct 22, 2018 (2 updates tracked since 2018).

About Charlie Isiah Wilson Jr. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHARLIE ISIAH WILSON JR. (NPI 1538635115) is an individual professional provider in Conway, South Carolina, licensed in South Carolina (8742) and active in the NPI registry since October 2018. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1538635115
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameCHARLIE ISIAH WILSON JR.
Location Address164 WACCAMAW MEDICAL PARK DRConway, SC 29526-8903
Mailing Address164 Waccamaw Medical Park DrConway, SC 29526-8903 · (843) 347-5060 · Fax (843) 347-3959
Phone(843) 347-5060
Fax(843) 347-3959
Sole ProprietorNo
Enumeration DateOctober 22, 2018
Last NPPES UpdateOctober 10, 20242 updates tracked since enumeration
NPPES CertifiedOctober 10, 2024
✔ NPI 1538635115 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
License✔ Licensed in SC · 8742
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 8742 (SC)
164 WACCAMAW MEDICAL PARK DR, Conway, SC 29526
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Charlie Isiah Wilson Jr. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. TAWAN BINNETTA ALSTON
Counselor
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060
MONICA LYNN JOHNSON MSW
Social Worker
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060
EMMETT MICHAEL LAMPKIN MD
Psychiatry & Neurology (Psychiatry)
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060
JANNIE LANCE MORANT
Counselor (Mental Health)
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060
JOSEPH E DEKINE
Counselor
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060
DR. EDWARD H CONNOR PH.D.
Counselor (Professional)
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060
RICHARD MOORER DANTZLER
Counselor
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060
MEGHAN NESMITH
Counselor (Mental Health)
164 WACCAMAW MEDICAL PARK DR
CONWAY, SC 29526
Horry County (843) 347-5060

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Charlie Wilson's NPI number?

The NPI number for Charlie Wilson is 1538635115. It was assigned to this individual provider in the NPPES registry on October 22, 2018.

Where is Charlie Wilson located?

Charlie Wilson practices at 164 Waccamaw Medical Park Dr, Conway, SC 29526. The listed phone number is (843) 347-5060.

What is Charlie Wilson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Is Charlie Wilson enrolled in Medicare?

Yes. Charlie Wilson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Charlie Wilson was last updated on October 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.