Organization
MOUNTAIN INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM RHETT WEAVER M.D. (PRESIDENT)
(706) 754-8518
Entity
Organization
Contact information
Practice address
835 AUSTIN DR, DEMOREST, GA 30535-4513
(706) 754-8518
(706) 754-6238
Mailing address
PO BOX 880, DEMOREST, GA 30535-0880
(706) 754-8518
(706) 754-6238
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
029819
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000509308A
—
GA
01
—
355686
WELLCARE
GA
Enumeration date
03/09/2006
Last updated
03/11/2008
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