Provider Demographics
NPI:1083878714
Name:WHARTON, DAVID L (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WHARTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1295 HEMBREE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5721
Mailing Address - Country:US
Mailing Address - Phone:770-752-9499
Mailing Address - Fax:770-752-9166
Practice Address - Street 1:1295 HEMBREE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5721
Practice Address - Country:US
Practice Address - Phone:770-752-9499
Practice Address - Fax:770-752-9166
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004030363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCDNFMedicare PIN