Organization
WEAVER CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY POUNDERS WEAVER FNP (MEDICAL SUPERVISOR)
(901) 262-0185
Entity
Organization
Contact information
Practice address
124 W COMMERCE ST, HERNANDO, MS 38632-2240
(901) 262-0185
Mailing address
124 W COMMERCE ST, HERNANDO, MS 38632-2240
(901) 262-0185
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
R629189
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122952
—
MS
Enumeration date
08/19/2014
Last updated
12/01/2014
Update your record
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