MR. JOHN CALEB WATES (NPI# 1639284938) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639284938 |
| Entity Type | Individual |
| Full Name | MR. JOHN CALEB WATES |
| Credential | APRN -BC, FNP |
| Practice Address |
100 Ridge Medical Plaza Rd Suite 102 Edgefield SC 29824-4535 |
| Practice Telephone | 8036373630 |
| Practice Fax Number | 8036375348 |
| Mailing Telephone | 8036373630 |
| Mailing Fax Number | 8036375348 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2015-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
F3009 | SC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | NP2197 | 05 | |
| SC | RHC552 | 05 | |
| SC | RHC548 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417042888 | John B. Wates Jr. | Marriage & Family Therapist | 531-a Oxford Street, Sumter, SC 29150 | 2006-10-03 |
| Street Address |
100 RIDGE MEDICAL PLAZA RD SUITE 102 |
| City | EDGEFIELD |
| State | SC |
| Zip Code | 29824-4535 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770969669 | Heather Trotter | Nurse Practitioner | 100 Ridge Medical Plaza Rd, Edgefield, SC 29824-4535 | 2015-08-03 |
| 1841350634 | Elizabeth S Gordineer | Family Medicine | 100 Ridge Medical Plaza Rd, Suite 102, Edgefield, SC 29824-4535 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386993483 | Kim Massey Holsomback | Pharmacist | 230 Apple Square Plaza, Edgefield, SC 29824 | 2012-09-05 |
| 1093962359 | Edgefield County Senior Citizens Council | Voluntary or Charitable | 15 Center Spring Road, Edgefield, SC 29824 | 2008-08-19 |
| 1114108735 | Banks Pharmacy | Clinic/Center | 100 Ridge Medical Plaza, Suite 101, Edgefield, SC 29824 | 2007-11-26 |
| 1255525648 | Carolina Youth Combat Systems | Counselor | 722 Augusta Rd, Edgefield, SC 29824 | 2007-08-29 |
| 1972663763 | Tami Y Massey | Family Medicine | 155 Ridge Medical Plaza Rd, Suite A, Edgefield, SC 29824 | 2006-12-11 |
| 1093166514 | Self Medical Group | Family Medicine | 155 Ridge Medical Plaza Rd, Suite A, Edgefield, SC 29824 | 2016-06-27 |
| 1376960955 | Carla Dorn | Licensed Practical Nurse | 21 Star Rd, Edgefield, SC 29824 | 2014-03-21 |
| 1487904819 | Julian Thomas Rushin | Pharmacist | 230 Apple Square Plaza, Edgefield, SC 29824 | 2012-09-13 |
| 1134478225 | Marvin Gene Cason | Pharmacist | 230 Apple Square Plaza, Edgefield, SC 29824 | 2012-09-05 |
| 1205197019 | Robert Brightharp | Family Medicine | 155 Ridge Medical Plaza, Suite 102, Edgefield, SC 29824 | 2012-06-07 |
| Find all providers in zip 29824 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750944401 | David Anthony Sandoval | Nurse Practitioner | 403 Buncombe St, Edgefield, SC 29824-1012 | 2019-04-18 |
| 1942783147 | Erika M Raines | Nurse Practitioner | 155 Ridge Medical Plaza Rd Ste B, Edgefield, SC 29824-4531 | 2018-09-13 |
| 1548695588 | Abraham James Weaver | Nurse Practitioner | 155 Ridge Medical Plaza Rd, Edgefield, SC 29824-4531 | 2013-09-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417557737 | Diondra Johnson | Nurse Practitioner | 2327 Watchtower Ln, Charleston, SC 29414-7803 | 2020-10-27 |
| 1740888262 | Gerri Kukucka | Nurse Practitioner | 18 Ash Ct, Irmo, SC 29063-9584 | 2020-10-16 |
| 1407454853 | William Andrew Haislip | Nurse Practitioner | 109 Anita St, Greer, SC 29651-3814 | 2020-10-16 |
| 1912505652 | Mattison Williams Craig | Nurse Practitioner | 108 Woodstock Ln, Greer, SC 29650-3918 | 2020-10-14 |
| 1669079901 | Kelley Brown Davis | Nurse Practitioner | 2689 Us-1, Elgin, SC 29045 | 2020-10-08 |
| 1518564897 | Erica Odom Mccumbers | Nurse Practitioner | 17 Downing Cir, Gilbert, SC 29054-8483 | 2020-10-08 |
| 1285231845 | Shannon Marie Dunlap | Nurse Practitioner | 3792 Home Branch Rd, Manning, SC 29102-4109 | 2020-10-07 |
| 1588261325 | Crystal Leopard | Nurse Practitioner | 328 Deer Creek Rd, Easley, SC 29640-7615 | 2020-10-05 |
| 1497352595 | Margaret Ann Regnery | Nurse Practitioner | 900 Island Park Dr Ste 104, Daniel Island, SC 29492-7560 | 2020-10-02 |
| 1417564709 | John P Rainchuso | Nurse Practitioner | 299 Three Runs Creek Way, Aiken, SC 29803-1680 | 2020-09-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.