Individual
TED W WEATHERRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, ROOM 2144, AUGUSTA, GA 30912-0004
(706) 721-3873
(706) 721-7763
Mailing address
PO BOX 28068, CHATTANOOGA, TN 37424-8068
(877) 899-1033
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
034979
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000542165B
—
GA
05
—
000542165C
—
GA
01
—
050031131
RRMEDICARE
GA
01
—
339267
WELLCARE CMO
GA
01
—
480929
BCBS
GA
01
—
550789920
TRICARE
GA
05
—
G34979
—
SC
Enumeration date
11/13/2006
Last updated
06/15/2008
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