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General NPI Number Information
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NPI Number | 1003268186
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Entity Type | Individual
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Provider Name | JEFFREY ALEXANDER WHARTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 67 CREEKSIDE PARK CT
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City | GREENVILLE
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State | SC
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Zip | 29615-4810
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Country | US
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Telephone | 864-522-3700
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Fax | 864-522-3705
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | LL39670
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 39670
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License Number State | SC
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