Healthcare Provider Details

I. General information

NPI: 1942689286
Provider Name (Legal Business Name): MARCUS K. WELDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 1ST ST STE 410
MACON GA
31201-8306
US

IV. Provider business mailing address

800 1ST ST STE 410
MACON GA
31201-8306
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-7068
  • Fax: 478-741-1354
Mailing address:
  • Phone: 478-743-7068
  • Fax: 478-741-1354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number76847
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: