Healthcare Provider Details

I. General information

NPI: 1326045311
Provider Name (Legal Business Name): WHEATON JOHN WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 GRAYSTONE PL SE
CONOVER NC
28613-8262
US

IV. Provider business mailing address

810 FAIRGROVE CHURCH RD
HICKORY NC
28602-9617
US

V. Phone/Fax

Practice location:
  • Phone: 828-326-3557
  • Fax: 828-326-3557
Mailing address:
  • Phone: 828-326-3557
  • Fax: 828-326-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number200100985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: