Provider Demographics
NPI:1578008934
Name:WEIGANDT, JEREMY
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:WEIGANDT
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 1:1019 SHADY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-1952
Mailing Address - Country:US
Mailing Address - Phone:248-802-2566
Mailing Address - Fax:
Practice Address - Street 1:SOUTHERN MEDICAL HEARING CENTERS
Practice Address - Street 2:2816 WASHINGTON RD STE 106
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2194
Practice Address - Country:US
Practice Address - Phone:706-412-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501005426237700000X
GAHADS001010237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist