Provider Demographics
NPI:1669426797
Name:CARR, WESLEY A (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:A
Last Name:CARR
Suffix:
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:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0839
Mailing Address - Country:US
Mailing Address - Phone:864-964-9155
Mailing Address - Fax:864-964-9111
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:STE 1240
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7917
Practice Address - Country:US
Practice Address - Phone:864-964-9155
Practice Address - Fax:864-964-9111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC131232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC131235Medicaid
SCD905957000Medicare PIN
SCD905957000Medicare ID - Type Unspecified