Provider Demographics
NPI:1477685949
Name:WEEKS, JOHNNY C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:C
Last Name:WEEKS
Suffix:
Gender:M
Credentials:MD
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 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:
Practice Address - Street 1:2075 EAGLE LANDING BLVD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4074
Practice Address - Country:US
Practice Address - Phone:843-797-5747
Practice Address - Fax:843-797-0857
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC16744OtherSTATE LICENSE
SC5551OtherMEDICARE GROUP #
SCGP4910OtherMEDICAID GROUP #
SCP00638295OtherRAILROAD MEDICARE
SC167447Medicaid
SC167447Medicaid