Healthcare Provider Details

I. General information

NPI: 1952072142
Provider Name (Legal Business Name): ELVIRA P WEEKES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 PAXTON LN SW APT 809
LILBURN GA
30047-8401
US

IV. Provider business mailing address

2595 CAPTAINS ROW
DECATUR GA
30035-3062
US

V. Phone/Fax

Practice location:
  • Phone: 404-441-2394
  • Fax:
Mailing address:
  • Phone: 706-473-9336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number138942
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: