| Doctor Name: | MR. JOHN CALEB WATES |
| NPI Number: | 1639284938 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN -BC, FNP |
| License Number: | F3009 |
| Business Practice Address: | 100 Ridge Medical Plaza Rd Suite 102 Edgefield, SC - 298244535 |
| Business Phone Number: | 8036373630 |
| Business Fax Number: | 8036375348 |
| Mailing Address: | 100 Ridge Medical Plaza Rd, Suite 102 EDGEFIELD |
| State: | SC |
| Postal Code: | 298244535 |
| Phone Number: | 8036373630 |
| Fax Number: | 8036375348 |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 04/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F3009 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |