Healthcare Provider Details

I. General information

NPI: 1003915372
Provider Name (Legal Business Name): HOWARD S. WELDON JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CENTER STREET SUITE 103
COLUMBUS GA
31901
US

IV. Provider business mailing address

700 CENTER STREET SUITE 103
COLUMBUS GA
31901
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-8375
  • Fax: 706-494-8378
Mailing address:
  • Phone: 706-494-8375
  • Fax: 706-494-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00006971
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number026200
License Number StateGA

VIII. Authorized Official

Name: PEGGY WELDON
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-494-8375