Priscilla Weaver

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Practice address

2310 Parklake Dr NE Ste 535
Atlanta, GA 30345-2911

Phone

(833) 615-1090

Fax

(470) 592-6088

NPI assigned

Jun 2, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• KMB Diagnostics LLC

  • Clinical Medical Laboratory
  • Atlanta, GA
  • NPI 1831868330
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1073189882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 PARKLAKE DR NE STE 535",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452911",
            "telephone_number": "833-615-1090",
            "fax_number": "470-592-6088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 PARKLAKE DR NE STE 535",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452911",
            "telephone_number": "833-615-1090",
            "fax_number": "470-592-6088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "PRISCILLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@405pmd.com",
            "affiliation": "N",
            "address_1": "2310 Parklake Dr NE Ste 535",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303452911",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Celeste Allison Weaver, REGISTERED NURSE
• Diondra Weaver
• John Weaver
• Katie Thomas Weaver, MPT
• Kimberly Weaver, PA-C
• Victoria Quaid Weaver, MS RD LD
• Webb Plastic Surgery
• Adam Christopher Webb, M.D.
• Bereaval Shamarol Webb, MD
• Bernadette Webb, DC

• Clinical Medical Laboratory in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.