MEDICARE: EVERETTE ARDEN WEATHERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	5244	SC
2	207R00000X	Internal Medicine Physician	5244	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	576008010-012	OTHER	SC	BCBS
2	32409	OTHER	SC	MEDCOST
3	9204593	OTHER	SC	CIGNA
4	622230	OTHER	SC	FIRST CHOICE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	9645030	OTHER	SC	GHI

General Provider Information

NPI Number	:	1033195490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVERETTE ARDEN WEATHERS MD

Provider Business Mailing Address
First Line	:	PO BOX 1245
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29116-1245
Country	:	US
Telephone Number	:	803-536-2555
Fax Number	:	803-536-0998

Provider Business Practice Location Address
First Line	:	1175 COOK RD
Second Line	:	SUITE 320
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8201
Country	:	US
Telephone Number	:	803-536-2555
Fax Number	:	803-536-0998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	05/03/2016

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Directions to “ EVERETTE ARDEN WEATHERS MD” Practice Location

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