1962440347 NPI number — WEATHERLY MEDICAL/CONSULTANTS, INC.

Table of content: MS. JOYCE FLORY COLEMAN RN (NPI 1700905882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962440347 NPI number — WEATHERLY MEDICAL/CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEATHERLY MEDICAL/CONSULTANTS, INC.
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:
1962440347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 395
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYBEE ISLAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31328-0395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-351-0760
Provider Business Mailing Address Fax Number:
912-351-0830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7135 HODGSON MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-2535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-351-0760
Provider Business Practice Location Address Fax Number:
912-351-0830
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEATHERLY
Authorized Official First Name:
DAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
912-351-0760

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , with the licence number:  532291 , 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: DE1066 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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