Provider Demographics
NPI:1699192310
Name:WHARTON, ANNETTE THOMAS
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:THOMAS
Last Name:WHARTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:THOAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-5241
Mailing Address - Country:US
Mailing Address - Phone:706-321-9606
Mailing Address - Fax:
Practice Address - Street 1:1230 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-5241
Practice Address - Country:US
Practice Address - Phone:706-321-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker