Provider Demographics
NPI:1598343451
Name:WEAVER, JOHN (AUD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 ALEXANDRIA LEIGH CIR
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-3005
Mailing Address - Country:US
Mailing Address - Phone:251-635-6306
Mailing Address - Fax:
Practice Address - Street 1:6722 ALEXANDRIA LEIGH CIR
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-3005
Practice Address - Country:US
Practice Address - Phone:251-635-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
GA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist