Provider Demographics
NPI:1154546927
Name:J. CAROLINE HANEY-WEAVER, M.D.
Entity type:Organization
Organization Name:J. CAROLINE HANEY-WEAVER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO-PRACITITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRIE
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:HANEY-WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-673-0092
Mailing Address - Street 1:930 E EMERALD AVE
Mailing Address - Street 2:SUITE 612
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4539
Mailing Address - Country:US
Mailing Address - Phone:865-673-0092
Mailing Address - Fax:865-637-3443
Practice Address - Street 1:930 E EMERALD AVE
Practice Address - Street 2:SUITE 612
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4539
Practice Address - Country:US
Practice Address - Phone:865-673-0092
Practice Address - Fax:865-637-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40791207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528086097OtherNPI
TN4131926OtherBLUE CROSS BLUE SHIELD
TN3736232Medicare ID - Type Unspecified