Healthcare Provider Details

I. General information

NPI: 1447220645
Provider Name (Legal Business Name): GEORGIA KIM WEEBER D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CONWAY ST GREENFIELD HEALTH CENTER
GREENFIELD MA
01301-1521
US

IV. Provider business mailing address

329 CONWAY ST GREENFIELD HEALTH CENTER
GREENFIELD MA
01301-1521
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-6301
  • Fax: 413-772-3314
Mailing address:
  • Phone: 413-774-6301
  • Fax: 413-772-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2163
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2163
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2163
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: