Provider Demographics
NPI:1235690322
Name:WEIR, JAYSON L
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:L
Last Name:WEIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 PLOWSON RD
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-0608
Mailing Address - Country:US
Mailing Address - Phone:678-764-4318
Mailing Address - Fax:
Practice Address - Street 1:778 PLOWSON RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-0608
Practice Address - Country:US
Practice Address - Phone:678-764-4318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN127376026OtherWORKERS COMPENSATION
TN127386026OtherWORKERS COMPENSATION
TN04031983OtherWORKERS COMPENSATION