Provider Demographics
NPI:1174121206
Name:FITCHETT, WILSON MCCALL (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:MCCALL
Last Name:FITCHETT
Suffix:
Gender:M
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:3495 IRON HORSE RD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4319
Practice Address - Country:US
Practice Address - Phone:843-793-5970
Practice Address - Fax:843-419-5391
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7162Medicaid