Provider Demographics
NPI:1285992412
Name:WEAVER, JONATHAN BERNARD (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BERNARD
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2146 BELCOURT AVE
Mailing Address - Street 2:VMG BUSINESS OFFICE
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212
Mailing Address - Country:US
Mailing Address - Phone:615-322-5000
Mailing Address - Fax:
Practice Address - Street 1:1211 MEDICAL CENTER DRIVE
Practice Address - Street 2:ANESTHESIOLOGY DEPARTMENT
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-936-1830
Practice Address - Fax:615-936-3412
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN51933207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program