Provider Demographics
NPI:1083889745
Name:WHEATLEY, GREGORY VAL (RD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:VAL
Last Name:WHEATLEY
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27314-0004
Mailing Address - Country:US
Mailing Address - Phone:336-562-3311
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PROSPECT HILL
Practice Address - State:NC
Practice Address - Zip Code:27314-0004
Practice Address - Country:US
Practice Address - Phone:336-562-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003165133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered