Healthcare Provider Details

I. General information

NPI: 1548078967
Provider Name (Legal Business Name): CELESTE ALLISON WEAVER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CELESTE ALLISON WARD

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD NE
ATLANTA GA
30322-4200
US

IV. Provider business mailing address

1146 TROPHY CLUB AVE
DACULA GA
30019-7589
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-9532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberRN300753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: