Healthcare Provider Details

I. General information

NPI: 1669517967
Provider Name (Legal Business Name): WESLEY G MERRIWETHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 COMMONWEALTH DR SUITE 200
GREENVILLE SC
29615-4883
US

IV. Provider business mailing address

131 COMMONWEALTH DR SUITE 200
GREENVILLE SC
29615-4883
US

V. Phone/Fax

Practice location:
  • Phone: 864-675-4600
  • Fax: 864-675-4604
Mailing address:
  • Phone: 864-675-4600
  • Fax: 864-675-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20461
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: