Individual
DALTON GLENN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
708 N HIGHLAND AVE, JACKSON, TN 38301-4829
(731) 394-0071
Mailing address
109 E LAFAYETTE ST, JACKSON, TN 38301-6203
(731) 300-4232
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028076
STATE VOLUNTEER MUTUAL INSURANCE COMPANY (SVMIC)
TN
Enumeration date
03/21/2018
Last updated
08/07/2019
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