Individual
JEFFREY S WEATHERALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 W RAVINE, STE 5B, KINGSPORT, TN 37660-3847
(423) 224-3460
(423) 224-3465
Mailing address
PO BOX 535744, ATLANTA, GA 30353-5510
(844) 294-5114
(865) 691-0843
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34933
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010258693
—
VA
05
—
3868408
—
TN
01
—
4119268
BCBST
—
05
—
64032592
—
KY
01
—
P00303258
RAILROAD MEDICARE
—
Enumeration date
05/31/2006
Last updated
04/12/2017
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