Provider Demographics
NPI:1801463930
Name:WEAVER, LAUREN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 CHATTANOOGA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2672
Mailing Address - Country:US
Mailing Address - Phone:706-876-2130
Mailing Address - Fax:706-876-2168
Practice Address - Street 1:1575 CHATTANOOGA AVE STE 1
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2672
Practice Address - Country:US
Practice Address - Phone:706-876-2130
Practice Address - Fax:706-876-2168
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA268643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily