Provider Demographics
NPI:1326045311
Name:WILLIAMS, WHEATON JOHN (MD)
Entity Type:Individual
Prefix:
First Name:WHEATON
Middle Name:JOHN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:810 FAIRGROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9617
Mailing Address - Country:US
Mailing Address - Phone:828-326-3557
Mailing Address - Fax:828-326-2922
Practice Address - Street 1:3412 GRAYSTONE PL SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8262
Practice Address - Country:US
Practice Address - Phone:828-326-3557
Practice Address - Fax:828-326-3557
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200100985207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790190GMedicaid
NC0190GOtherBCBS OF NC
NC89133F5Medicaid
NC133F5OtherNC BLUE CROSS BLUE SHIELD
NC133F5OtherNC BLUE CROSS BLUE SHIELD
NC790190GMedicaid
NC89133F5Medicaid