Individual
MR. LISTON ALEXANDER WEATHERLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1268 S 4TH ST, HARTSVILLE, SC 29550-0703
(803) 484-5317
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
21363
SC
Other
Enumeration date
12/15/2017
Last updated
09/22/2021
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