Individual
STEVEN GLENN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23 WEATHERFORD SQ, JACKSON, TN 38305-2202
(731) 217-3799
(731) 422-0432
Mailing address
23 WEATHERFORD SQ, JACKSON, TN 38305-2202
(731) 394-4520
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD28076
TN
207RA0401X
Addiction Medicine (Internal Medicine) Physician
MD28076
TN
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
MD28076
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3803406
—
TN
Enumeration date
03/14/2006
Last updated
01/31/2023
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