Provider Demographics
NPI:1497729230
Name:WHEELER, HUGH AVERY (PA-C)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:AVERY
Last Name:WHEELER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5012
Mailing Address - Country:US
Mailing Address - Phone:704-283-8888
Mailing Address - Fax:704-283-5747
Practice Address - Street 1:1301 DOVE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5012
Practice Address - Country:US
Practice Address - Phone:704-283-8888
Practice Address - Fax:704-283-5747
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103889363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950093Medicaid
SC0418PAMedicaid
SC0418PAMedicaid
NC2766096Medicare PIN
NC2766096BMedicare PIN