Individual
TARA ANN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 LAKE MURRAY BLVD, COLUMBIA, SC 29212-8623
(803) 731-9600
Mailing address
117 WHITE BIRCH CT, LEXINGTON, SC 29073-6905
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6140
SC
Other
Enumeration date
11/14/2025
Last updated
11/14/2025
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