Provider Demographics
NPI:1801899554
Name:WEAVER, CHARLES EDWARD JR (MD PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:STE 310
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4947
Mailing Address - Country:US
Mailing Address - Phone:770-664-9600
Mailing Address - Fax:770-664-9856
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 170
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8029
Practice Address - Country:US
Practice Address - Phone:770-721-9540
Practice Address - Fax:770-721-9541
Is Sole Proprietor?:No
Enumeration Date:2005-05-25
Last Update Date:2021-02-26
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Provider Licenses
StateLicense IDTaxonomies
GA56242207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA642893452AMedicaid
854350OtherBCBS OF GA
GA14BDHKMMedicare PIN
GA642893452AMedicaid