Provider Demographics
NPI:1588383350
Name:WEAVER MEDICAL
Entity type:Organization
Organization Name:WEAVER MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:865-748-6208
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-0063
Mailing Address - Country:US
Mailing Address - Phone:865-748-6208
Mailing Address - Fax:423-839-1602
Practice Address - Street 1:231 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2036
Practice Address - Country:US
Practice Address - Phone:423-839-1600
Practice Address - Fax:423-839-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty