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Organization
WHEATON PEDIATRICS LLC
Active
Organization
WHEATON PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN WHEATON MD (OWNER)
(843) 437-2545
Entity
Organization
Contact information
Practice address
354 FOLLY RD, SUITE #5, CHARLESTON, SC 29412-2594
(843) 437-2545
Mailing address
6445 E BRIMLEY DR, NAMPA, ID 83687-4119
(843) 437-2545
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
23312
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4277
—
SC
Enumeration date
05/08/2006
Last updated
05/23/2016
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