Provider Demographics
NPI:1457340465
Name:CULPEPPER, JOHN WESLEY JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WESLEY
Last Name:CULPEPPER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W ALEXANDER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4009
Mailing Address - Country:US
Mailing Address - Phone:864-223-0505
Mailing Address - Fax:864-223-7075
Practice Address - Street 1:305 W ALEXANDER AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4009
Practice Address - Country:US
Practice Address - Phone:864-223-0505
Practice Address - Fax:864-223-7075
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25237208200000X
WV22043208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46673Medicare UPIN
WV3810003833Medicaid
P00303865Medicare PIN
I46673Medicare UPIN
P00303865OtherRAILROAD MEDICARE