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General NPI Number Information
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NPI Number | 1093763245
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Entity Type | Individual
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Provider Name | DANITA RONIQUE WEARY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 136 JEFFERSON DAVIS BLVD
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City | NATCHEZ
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State | MS
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Zip | 39120-5104
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Country | US
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Telephone | 601-442-5439
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Fax | 601-442-3755
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Provider Business Mailing Address
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Address Line | PO BOX 17918
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City | NATCHEZ
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State | MS
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Zip | 39122-7918
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Country | US
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Telephone | 601-442-5439
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Fax | 601-442-3755
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 18242
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License Number State | MS
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