Provider Demographics
NPI:1639767825
Name:BEWEAVEUS LLC
Entity Type:Organization
Organization Name:BEWEAVEUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:PAULETTE
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-539-5662
Mailing Address - Street 1:710 DACULA RD STE 4A249
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7061
Mailing Address - Country:US
Mailing Address - Phone:770-539-5652
Mailing Address - Fax:
Practice Address - Street 1:710 DACULA RD STE 4A249
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7061
Practice Address - Country:US
Practice Address - Phone:770-539-5652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment