Provider Information for 1164090684
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BRETT WEAVER LPC
Sex: Male
NPI: 1164090684
Last Updated: 2024-01-08
Certification Date: 2024-01-08
Certification Date: 2024-01-08
Details
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NPI | 1164090684 | ||||||||
Enumeration Date | 2021-06-11 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | YES | ||||||||
Status | Active | ||||||||
Mailing Address | 2408 LEE STREET RD AMERICUS, GA 31709-9249 United States Phone: 806-367-2176 | Fax: | ||||||||
Primary Practice Address | 2408 LEE STREET RD AMERICUS, GA 31709-9249 United States Phone: 806-367-2176 | Fax: | ||||||||
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