Provider Demographics
NPI:1316176324
Name:WHITLEY, JOHN CALVIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CALVIN
Last Name:WHITLEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1315 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-7631
Mailing Address - Country:US
Mailing Address - Phone:803-640-6544
Mailing Address - Fax:803-278-7318
Practice Address - Street 1:1315 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-7631
Practice Address - Country:US
Practice Address - Phone:803-640-6544
Practice Address - Fax:803-278-7318
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL50882084P0800X
SC91672084P0800X
NC170502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63938Medicare UPIN