Weatherly Sports Medicine & Family Orthopaedics, PA

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

WEATHERLY SPORTS MEDICINE & FAMILY ORTHOPAEDICS, PA

Practice address

1801 Crane Ridge Dr
Suite C
Jackson, MS 39216-4902

Phone

(601) 981-5633

Fax

(601) 981-1844

NPI assigned

Oct 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Wallace W Weatherly III, M.D.

Title

Physician/Owner

Phone

(601) 856-5633

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Barry Gale Munn, MD

  • Orthopaedic Surgery Physician
  • Gainesville, GA
  • NPI 1609882034
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395964800000",
    "number": "1215025358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1154",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391301154",
            "telephone_number": "601-981-5633",
            "fax_number": "601-981-1844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 CRANE RIDGE DR",
            "address_2": "SUITE C",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164902",
            "telephone_number": "601-981-5633",
            "fax_number": "601-981-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEATHERLY SPORTS MEDICINE & FAMILY ORTHOPAEDICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2014-03-28",
        "status": "A",
        "authorized_official_last_name": "WEATHERLY",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "601-856-5633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07105081",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WBF Choice Healthcare, Inc
• WC Enterprise and Services
• WCRL, LLC
• We Care Home Healthcare, LLC
• We Care Home Services, LLC
• Brandon B Weatherly, M.D.
• Lyssa Taylor Weatherly, M.D.
• Wallace W Weatherly, M.D.
• Coronda Weathersby
• Courtney Weathersby

• Orthopaedic Surgery Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Orthopaedic Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; 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.