Healthcare Provider Details

I. General information

NPI: 1407857691
Provider Name (Legal Business Name): MORRILL HARRINGTON WEAVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FACILITY DR
CLYDE NC
28721-9438
US

IV. Provider business mailing address

15 FACILITY DR
CLYDE NC
28721-9438
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-2211
  • Fax: 855-732-4561
Mailing address:
  • Phone: 828-452-2211
  • Fax: 855-732-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number200001487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: