Provider Demographics
NPI:1356449805
Name:WEATHERS, DWIGHT R (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:R
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY UNIVERSITY HOSPITAL
Mailing Address - Street 2:1364 CLIFTON RD, NE, ROOM C179-B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-712-0585
Mailing Address - Fax:404-712-4780
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL
Practice Address - Street 2:1364 CLIFTON RD, NE, ROOM C179-B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-712-0585
Practice Address - Fax:404-712-4780
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0066991223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology