Healthcare Provider Details

I. General information

NPI: 1043004997
Provider Name (Legal Business Name): CRISTY WEEMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 NOAH DR
JASPER GA
30143-8721
US

IV. Provider business mailing address

1500 1ST AVE N UNIT 3
BIRMINGHAM AL
35203-1866
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-1954
  • Fax:
Mailing address:
  • Phone: 205-545-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN272571
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: