Provider Demographics
NPI:1962440347
Name:WEATHERLY MEDICAL/CONSULTANTS, INC.
Entity Type:Organization
Organization Name:WEATHERLY MEDICAL/CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-351-0760
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-0395
Mailing Address - Country:US
Mailing Address - Phone:912-351-0760
Mailing Address - Fax:912-351-0830
Practice Address - Street 1:7135 HODGSON MEMORIAL DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2535
Practice Address - Country:US
Practice Address - Phone:912-351-0760
Practice Address - Fax:912-351-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA532291332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1066Medicaid