Basic Information
| Provider Information | |||||||||
| NPI: | 1679557805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEAVER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | RHETT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705334786 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 AUSTIN DR | ||||||||
| Address2: | |||||||||
| City: | DEMOREST | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305354513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067548518 | ||||||||
| FaxNumber: | 7067546238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 029819 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | DG0044 | 01 | GA | RR MEDICARE GROUP | OTHER | 355686 | 01 | GA | WELLCARE | OTHER | 000509308A | 05 | GA | MEDICAID |