1558354282 NPI number — DR. GEORGE SAMUEL WHAM JR. EDD, SCAT, ATC

Table of content: DR. GEORGE SAMUEL WHAM JR. EDD, SCAT, ATC (NPI 1558354282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558354282 NPI number — DR. GEORGE SAMUEL WHAM JR. EDD, SCAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHAM
Provider First Name:
GEORGE
Provider Middle Name:
SAMUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
EDD, SCAT, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558354282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 CORLEY MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29072-8403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-821-0847
Provider Business Mailing Address Fax Number:
803-894-2101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 LYDIA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELION
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29123-9812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-894-2276
Provider Business Practice Location Address Fax Number:
803-894-2121
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  275 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 275 . This is a "SC DHEC AT CERTIFICATION NUNBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com