Provider Demographics
NPI:1285439737
Name:WEAVER, TYRIK DEVON (BACHELORS)
Entity type:Individual
Prefix:
First Name:TYRIK
Middle Name:DEVON
Last Name:WEAVER
Suffix:
Gender:
Credentials:BACHELORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 BILLUPS ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-1126
Mailing Address - Country:US
Mailing Address - Phone:762-815-9295
Mailing Address - Fax:
Practice Address - Street 1:1074 S MAIN ST NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-4847
Practice Address - Country:US
Practice Address - Phone:762-815-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst