Provider Demographics
NPI:1306806625
Name:WEAVER, NIKKI DEGEORGE (AUD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:DEGEORGE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:NIKKI
Other - Middle Name:JEAN
Other - Last Name:DEGEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2301 NEWNAN CROSSING BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265
Mailing Address - Country:US
Mailing Address - Phone:770-254-2224
Mailing Address - Fax:770-254-2225
Practice Address - Street 1:2301 NEWNAN CROSSING BLVD
Practice Address - Street 2:STE 160
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-254-2224
Practice Address - Fax:770-254-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003619237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA216785196AMedicaid
GAQ08874Medicare UPIN