=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922230580
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERON WEEKS RD,LD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2009
-----------------------------------------------------
Last Update Date | 08/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 WATERS AVE FOOD & NUTRITION SERVICES
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31403-3089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-350-9064
-----------------------------------------------------
Fax | 912-350-9557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 WATERS AVE FOOD & NUTRITION SERVICES
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31403-3089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-350-9064
-----------------------------------------------------
Fax | 912-350-9557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | LD003381
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------