MEDICARE: SAADIA KHAN WHATLEY, DPM L.L.C.

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	213E00000X	Podiatrist	629	SC

General Provider Information

NPI Number	:	1942634001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAADIA KHAN WHATLEY, DPM L.L.C.

Provider Business Mailing Address
First Line	:	910 SPINDLE ST APT 402
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-3336
Country	:	US
Telephone Number	:	256-497-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 OFFICE PARK CT STE 103
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5948
Country	:	US
Telephone Number	:	256-497-0032
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAADIA KHAN WHATLEY
Credential	:	DPM
Telephone Number	:	256-497-0032

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	08/26/2013

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