Healthcare Provider Details

I. General information

NPI: 1235259466
Provider Name (Legal Business Name): DORIS M WEAVER APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 ATHENS ST
GAINESVILLE GA
30507-7000
US

IV. Provider business mailing address

601 S ENOTA DR NE SUITE Q
GAINESVILLE GA
30501-2400
US

V. Phone/Fax

Practice location:
  • Phone: 770-531-5654
  • Fax: 770-532-5341
Mailing address:
  • Phone: 770-219-8420
  • Fax: 770-219-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN092374
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN092374
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: