Healthcare Provider Details

I. General information

NPI: 1568609287
Provider Name (Legal Business Name): ALAN DAVIS WEATHERFORD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 06/07/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W CHURCH ST
LEXINGTON TN
38351-2038
US

IV. Provider business mailing address

9486 HIGHWAY 412 W
LEXINGTON TN
38351-5713
US

V. Phone/Fax

Practice location:
  • Phone: 731-968-3646
  • Fax: 731-968-1870
Mailing address:
  • Phone: 731-968-0984
  • Fax: 731-967-9764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1676
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1676
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1676
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1676
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1676
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1676
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number1676
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1676
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: