MEDICARE: MS. VICTORIA QUAID WEAVER MS RD LD

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	133V00000X	Registered Dietitian	000093	GA

General Provider Information

NPI Number	:	1891910071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICTORIA QUAID WEAVER MS RD LD

Provider Business Mailing Address
First Line	:	3283 CHIPPING WOOD CT
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-4304
Country	:	US
Telephone Number	:	404-875-9919
Fax Number	:	770-442-3210

Provider Business Practice Location Address
First Line	:	1016 PIEDMONT AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-3702
Country	:	US
Telephone Number	:	404-875-9919
Fax Number	:	770-442-3210

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

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	08/29/2007

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