MEDICARE: GEORGE CLARK WEEKS JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	017507	GA

General Provider Information

NPI Number	:	1578194106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE CLARK WEEKS JR.

Provider Business Mailing Address
First Line	:	257 CEDARS GLEN CIR
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-4479
Country	:	US
Telephone Number	:	770-366-7597
Fax Number	:	770-218-8621

Provider Business Practice Location Address
First Line	:	1690 POWDER SPRINGS RD SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-4844
Country	:	US
Telephone Number	:	770-218-8171
Fax Number	:	770-218-8621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2020
Last Update Date	:	02/02/2020

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