Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 934 | SC |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 934 | SC |
N | 208200000X | Surgeon | SC LL 934 | SC |
N | 208600000X | Surgeon | SC LL 934 | SC |
Y | 208D00000X | General Practice Physician | 934 | SC |
NPI | 1164545224 |
---|---|
Provider Name | Dr. Kerry Lewayne Wheeler |
First Address | Atlanta, GA 30353-8622 |
Second Address | Chapin, SC 29036-7576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 14/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GP4551 | (05) | SC |