Basic Information
| Provider Information | |||||||||
| NPI: | 1447220645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEEBER | ||||||||
| FirstName: | GEORGIA | ||||||||
| MiddleName: | KIM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 CONWAY ST | ||||||||
| Address2: | GREENFIELD HEALTH CENTER | ||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013011521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137746301 | ||||||||
| FaxNumber: | 4137723314 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 CONWAY ST | ||||||||
| Address2: | GREENFIELD HEALTH CENTER | ||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013011521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137746301 | ||||||||
| FaxNumber: | 4137723314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 07/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 2163 | MA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0131X | 2163 | MA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213EP1101X | 2163 | MA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | Y75094 | 01 | MA | MEDICARE | OTHER | 3715511 | 01 | MA | AETNA | OTHER | Y75094 | 01 | MA | BLUE CROSS AND BLUE SHIEL | OTHER | 453533 | 01 | MA | TUFTS | OTHER | 333437 | 01 | MA | HARVARD PILGRIM HEALTH PL | OTHER | 28487 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 756223 | 01 | MA | CONNECTICARE | OTHER | 4223254003 | 01 | MA | CIGNA | OTHER | 000000022096 | 01 | MA | BMC HEALTHNET | OTHER |