Provider Demographics
NPI:1447448204
Name:WEAVER, VALENCIA (NP-C APRN)
Entity type:Individual
Prefix:
First Name:VALENCIA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:NP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 WINN WAY
Mailing Address - Street 2:SUITE A-210
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1712
Mailing Address - Country:US
Mailing Address - Phone:404-294-7033
Mailing Address - Fax:404-296-4661
Practice Address - Street 1:497 WINN WAY
Practice Address - Street 2:SUITE A-210
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1712
Practice Address - Country:US
Practice Address - Phone:404-294-7033
Practice Address - Fax:404-296-4661
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN091813363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I500114Medicare UPIN
GA511I500114Medicare PIN