Individual
MR. JOHN CALEB WATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN -BC, FNP
Contact information
Practice address
155 RIDGE MEDICAL PLAZA RD, EDGEFIELD, SC 29824-4531
(803) 637-3146
(803) 637-6597
Mailing address
155 RIDGE MEDICAL PLAZA RD, EDGEFIELD, SC 29824-4531
(803) 637-3146
(803) 637-6597
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F3009
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2197
—
SC
05
—
RHC548
—
SC
05
—
RHC552
—
SC
Enumeration date
08/20/2006
Last updated
12/28/2021
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