Provider Demographics
NPI:1679158331
Name:WEAVER, COLBY JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:JAMES
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 STAR DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3415
Mailing Address - Country:US
Mailing Address - Phone:520-906-9066
Mailing Address - Fax:
Practice Address - Street 1:2126 HIGHWAY 81 N
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1532
Practice Address - Country:US
Practice Address - Phone:864-332-9753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist