Healthcare Provider Details

I. General information

NPI: 1043948771
Provider Name (Legal Business Name): TIMOTHY WEEKS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S MAIN ST
ENGLEWOOD OH
45322-2819
US

IV. Provider business mailing address

200 BRIAR AVE NE
NORTH CANTON OH
44720-2621
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007691RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: