# QUINTON W WELDON ESTATE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750546958
- **Authorized official:** MRS. LISA M WELDON EXECUTOR/OWNER (EXECUTOR)
- **Authorized official phone:** (229) 928-3920

## Contact information

- **Practice address:** 100 PLANTATION RIDGE DRIVE, SUITE D, AMERICUS, GA 31709
- **Practice address phone:** (229) 928-3920
- **Practice address fax:** (229) 928-3921
- **Mailing address:** P.O. BOX 546, AMERICUS, GA 31709
- **Mailing address phone:** (229) 928-3920
- **Mailing address fax:** (229) 928-3921

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 056786 | GA | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/28/2008
- **Last updated:** 04/23/2015