Healthcare Provider Details

I. General information

NPI: 1912039629
Provider Name (Legal Business Name): ANDREA WELTER P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CARLTON ST
ATHENS GA
30602-1503
US

IV. Provider business mailing address

55 CARLTON ST
ATHENS GA
30602-1503
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-8621
  • Fax: 706-583-0217
Mailing address:
  • Phone: 404-556-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002611
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: