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General NPI Number Information
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NPI Number | 1063481224
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Entity Type | Individual
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Provider Name | JUDY E WEAVER APRNBC
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Gender | Female
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 1007 GREENFIELD DR
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City | TIFTON
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State | GA
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Zip | 31794-3795
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Country | US
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Telephone | 229-382-9733
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Fax | 229-387-6161
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Provider Business Mailing Address
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Address Line | 907 18TH ST E STE 400
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City | TIFTON
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State | GA
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Zip | 31794-3684
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Country | US
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Telephone | 229-353-3422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R089815
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN089815
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License Number State | GA
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