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NPI Code Detail

MEDICARE: THOMAS DARRELL WELDON M.D.

MEDICARE: THOMAS DARRELL WELDON M.D.
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
1207V00000XObstetrics & Gynecology Physician0227745GA
2207V00000XObstetrics & Gynecology Physician17843TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10079017OTHERTNTN BCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4024677OTHERGAGA BCBS

General Provider Information

NPI Number : 1164465597
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS DARRELL WELDON M.D.
Provider Business Mailing Address
First Line : 2009 OLD LAFAYETTE ROAD
Second Line :
City : FORT OGLETHORPE
State : GA
Zip : 30742-3510
Country : US
Telephone Number : 706-861-5950
Fax Number : 706-858-0475
Provider Business Practice Location Address
First Line : 2009 OLD LAFAYETTE RD
Second Line :
City : FT OGLETHORPE
State : GA
Zip : 30742-3510
Country : US
Telephone Number : 706-861-5950
Fax Number : 706-858-0475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 03/01/2012

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