Healthcare Provider Details

I. General information

NPI: 1336102904
Provider Name (Legal Business Name): MATTHEW G WEEKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 MITCHELL ST
LORIS SC
29569-2827
US

IV. Provider business mailing address

4000 HIGHWAY 9 E
LITTLE RIVER SC
29566-7833
US

V. Phone/Fax

Practice location:
  • Phone: 843-390-8159
  • Fax:
Mailing address:
  • Phone: 843-390-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number187312
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number85346
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD85346
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerSTATE LICENSE
# 2
Identifier187312
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: