Healthcare Provider Details

I. General information

NPI: 1184398141
Provider Name (Legal Business Name): COURTNEY SPILLANE WEEKS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N PARK TRL STE B
STOCKBRIDGE GA
30281-7372
US

IV. Provider business mailing address

150 N PARK TRL STE B
STOCKBRIDGE GA
30281-7372
US

V. Phone/Fax

Practice location:
  • Phone: 770-507-0909
  • Fax: 770-507-1919
Mailing address:
  • Phone: 770-507-0909
  • Fax: 770-507-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: