Provider Demographics
NPI:1861884512
Name:WEAVER, LESLIE (NP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6553 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2641
Mailing Address - Country:US
Mailing Address - Phone:706-965-6000
Mailing Address - Fax:706-965-8000
Practice Address - Street 1:6553 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2641
Practice Address - Country:US
Practice Address - Phone:706-965-6000
Practice Address - Fax:706-965-8000
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner