Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 017901 | GA |
N | 207RA0401X | Internist - Addiction Medicine | 017901 | GA |
NPI | 1003011958 |
---|---|
Provider Name | Dr. James Daniel Weathers |
First Address | Statesboro, GA 30458-2001 |
Second Address | Statesboro, GA 30458-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2007 |
Last Update Date | 02/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C23242 | (02) | GA |