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General NPI Number Information
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NPI Number | 1730182932
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Entity Type | Individual
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Provider Name | BENJAMIN BLAKE WEATHERSBY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 3815 FABER PLACE DR
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-8533
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Country | US
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Telephone | 843-767-9312
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Fax | 843-767-9313
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Provider Business Mailing Address
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Address Line | 3815 FABER PLACE DR
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City | CHARLESTON
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State | SC
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Zip | 29405-8533
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Country | US
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Telephone | 843-767-9312
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Fax | 843-767-9313
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 23772
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License Number State | SC
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