Provider Demographics
NPI:1164465597
Name:WELDON, THOMAS DARRELL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DARRELL
Last Name:WELDON
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 1:2009 OLD LAFAYETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3510
Mailing Address - Country:US
Mailing Address - Phone:706-861-5950
Mailing Address - Fax:706-858-0475
Practice Address - Street 1:2009 OLD LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3510
Practice Address - Country:US
Practice Address - Phone:706-861-5950
Practice Address - Fax:706-858-0475
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0227745207V00000X
TN17843207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0079017OtherTN BCBS
TN3030173Medicaid
GA000331471CMedicaid
GA024677OtherGA BCBS
GA024677OtherGA BCBS
GAA99407Medicare UPIN
TN3030173Medicare ID - Type UnspecifiedTN MEDICARE