MEDICARE: JOHN WEAVER

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	1223G0001X	General Practice Dentistry	10938	GA

General Provider Information

NPI Number	:	1669518577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WEAVER

Provider Business Mailing Address
First Line	:	2797 CAMPBELLTON RD SW
Second Line	:	SUITE A-4
City	:	ATLANTA
State	:	GA
Zip	:	30311-4455
Country	:	US
Telephone Number	:	404-346-1120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2797 CAMPBELLTON RD SW
Second Line	:	SUITE A-4
City	:	ATLANTA
State	:	GA
Zip	:	30311-4455
Country	:	US
Telephone Number	:	404-346-1120
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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Directions to “ JOHN WEAVER ” Practice Location

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