Provider Demographics
NPI:1790814002
Name:WHEEDLETON, MINERVA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MINERVA
Middle Name:C
Last Name:WHEEDLETON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 BEARGRASS TRL
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7962
Mailing Address - Country:US
Mailing Address - Phone:229-226-8713
Mailing Address - Fax:
Practice Address - Street 1:168 BEARGRASS TRL
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7962
Practice Address - Country:US
Practice Address - Phone:229-226-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics