Provider Demographics
NPI:1578780730
Name:WEEDEN, DENNITRA G (DC)
Entity Type:Individual
Prefix:MS
First Name:DENNITRA
Middle Name:G
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 SATELLITE BLVD NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7149
Mailing Address - Country:US
Mailing Address - Phone:770-614-7242
Mailing Address - Fax:770-614-7243
Practice Address - Street 1:105 SATELLITE BLVD NW
Practice Address - Street 2:SUITE D
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7149
Practice Address - Country:US
Practice Address - Phone:770-614-7242
Practice Address - Fax:770-614-7243
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007974111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor