Healthcare Provider Details

I. General information

NPI: 1437150455
Provider Name (Legal Business Name): ROBERT G. WEATHERSTONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MANCHESTER EXPY STE A201
COLUMBUS GA
31904-6802
US

IV. Provider business mailing address

2300 MANCHESTER EXPY STE 2001A
COLUMBUS GA
31904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-2766
  • Fax: 706-320-2768
Mailing address:
  • Phone: 706-320-3126
  • Fax: 706-320-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number026814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: