1447449434 NPI number — ROSEANN RIGBY WEAVER, M D, PC

Table of content: (NPI 1447449434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447449434 NPI number — ROSEANN RIGBY WEAVER, M D, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEANN RIGBY WEAVER, M D, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1447449434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
172 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30650-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-342-4106
Provider Business Mailing Address Fax Number:
706-343-0046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
172 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30650-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-342-4106
Provider Business Practice Location Address Fax Number:
706-343-0046
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEAVER
Authorized Official First Name:
ROSE ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
706-342-4106

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  13701 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00024032A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com