Provider Demographics
NPI:1407485303
Name:WEAVER, JULIE (RDH)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 CATTLE XING
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7759
Mailing Address - Country:US
Mailing Address - Phone:614-774-5384
Mailing Address - Fax:
Practice Address - Street 1:709 PETERSON AVE N
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-4911
Practice Address - Country:US
Practice Address - Phone:912-384-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist