Provider Demographics
NPI:1821188343
Name:WEAVER, ADRIAN TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:TODD
Last Name:WEAVER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4174 MULLIKIN RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4806
Mailing Address - Country:US
Mailing Address - Phone:706-868-8145
Mailing Address - Fax:706-868-7281
Practice Address - Street 1:4174 MULLIKIN RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4806
Practice Address - Country:US
Practice Address - Phone:706-868-8145
Practice Address - Fax:706-868-7281
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0112911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice