Healthcare Provider Details

I. General information

NPI: 1659382380
Provider Name (Legal Business Name): JOHN FRANCIS WEAVER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE VAMC MEMPHIS/MHS/116A5
MEMPHIS TN
38104
US

IV. Provider business mailing address

3593 MARIETTA BLVD
BARTLETT TN
38135-2621
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax: 901-577-7467
Mailing address:
  • Phone: 901-523-8990
  • Fax: 901-577-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP0000002233
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: