MEDICARE: WHEATON JOHN WILLIAMS 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	207RI0200X	Infectious Disease Physician	200100985	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0190G	OTHER	NC	BCBS OF NC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	133F5	OTHER	NC	NC BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1326045311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHEATON JOHN WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	810 FAIRGROVE CHURCH RD
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-9617
Country	:	US
Telephone Number	:	828-326-3557
Fax Number	:	828-326-2922

Provider Business Practice Location Address
First Line	:	3412 GRAYSTONE PL SE
Second Line	:
City	:	CONOVER
State	:	NC
Zip	:	28613-8262
Country	:	US
Telephone Number	:	828-326-3557
Fax Number	:	828-326-3557

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	02/01/2012

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