MEDICARE: MARY HANNAH WHEELER OD

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	390200000X	Student in an Organized Health Care Education/Training Program	2490	SC

General Provider Information

NPI Number	:	1851134258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY HANNAH WHEELER OD

Provider Business Mailing Address
First Line	:	414 CLIFTON GROVE ST
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-3413
Country	:	US
Telephone Number	:	912-286-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 FARMFIELD AVE STE C
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7755
Country	:	US
Telephone Number	:	843-890-8037
Fax Number	:

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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