Provider Demographics
NPI:1063443810
Name:WEEMS, DAVID HALE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HALE
Last Name:WEEMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 COACH LEE HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4764
Mailing Address - Country:US
Mailing Address - Phone:912-764-3037
Mailing Address - Fax:912-764-3829
Practice Address - Street 1:27 LESTER RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4764
Practice Address - Country:US
Practice Address - Phone:912-764-3037
Practice Address - Fax:912-764-3829
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14273174400000X
GA028100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00343813BMedicaid
SCG28100Medicaid
GA00343813BMedicaid
SCG28100Medicaid