Provider Demographics
NPI:1003915372
Name:HOWARD S. WELDON JR MD PC
Entity Type:Organization
Organization Name:HOWARD S. WELDON JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-494-8375
Mailing Address - Street 1:700 CENTER STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901
Mailing Address - Country:US
Mailing Address - Phone:706-494-8375
Mailing Address - Fax:706-494-8378
Practice Address - Street 1:700 CENTER STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-494-8375
Practice Address - Fax:706-494-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026200208600000X
AL00006971208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000136188EMedicaid
AL529914430Medicaid
GA000136188DMedicaid
GA000136188EMedicaid
C71105Medicare UPIN