Provider Demographics
NPI:1205075777
Name:WEEKS, SCOTT ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:WEEKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:1348 S 18TH ST STE 200
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4785
Practice Address - Country:US
Practice Address - Phone:042-619-7869
Practice Address - Fax:904-277-4143
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06274363A00000X
GA5482363A00000X
SC3426363A00000X
FLPA9110231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA184951345IMedicaid
GA184951345KMedicaid
GA184951345JMedicaid
GA184951345IMedicaid