MEDICARE: DR. JOHN CALVIN WHITLEY JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	5088	AL
2	2084P0800X	Psychiatry Physician	9167	SC
3	2084P0800X	Psychiatry Physician	17050	NC

General Provider Information

NPI Number	:	1316176324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CALVIN WHITLEY JR. M.D.

Provider Business Mailing Address
First Line	:	1315 W MARTINTOWN RD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-7631
Country	:	US
Telephone Number	:	803-640-6544
Fax Number	:	803-278-7318

Provider Business Practice Location Address
First Line	:	1315 W MARTINTOWN RD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29860-7631
Country	:	US
Telephone Number	:	803-640-6544
Fax Number	:	803-278-7318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2009
Last Update Date	:	07/15/2009

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