Individual
EVERETTE ARDEN WEATHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1175 COOK RD, SUITE 320, ORANGEBURG, SC 29118-8201
(803) 536-2555
(803) 536-0998
Mailing address
PO BOX 1245, ORANGEBURG, SC 29116-1245
(803) 536-2555
(803) 536-0998
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5244
SC
208600000X
Surgery Physician
Primary
5244
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052445
—
SC
01
—
32409
MEDCOST
SC
01
—
576008010-012
BCBS
SC
01
—
622230
FIRST CHOICE
SC
01
—
9204593
CIGNA
SC
01
—
9645030
GHI
SC
Enumeration date
12/19/2005
Last updated
05/03/2016
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