Berthina Gaynell Weaver, PRACTICLE NURSE
Individual provider Active NPI Licensed Practical Nurse · Rex, GA
NPI 1235668682 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1235668682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- LPN064458 (GA)
- Practice address
- 5820 Rex Ridge Loop
Rex, GA 30273 - Phone
- (404) 643-4050
- NPI assigned
- Jun 8, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 064458 | GA | MD | Licensed Practical Nurse |
| LPN064458 | GA | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 064458 | GA | |
| Licensed Practical Nurse | 164W00000X | LPN064458 | GA | Yes |
Addresses
Primary practice location
5820 Rex Ridge Loop
Rex, GA 30273
Mailing address
5820 Rex Ridge Loop
Rex, GA 30273-5240
Phone (404) 643-4050
Other providers in Rex, GA
- Lakeisha Varner
- Shanasia Victrum
- Vonetta Williams Enterprise LLC
- Walgreen Co
- Patricia Watson
- Rachel L Whitfield
- Nicole Sherrette Williams
- Ralph Bernard Willliams
- Akwasi G Yeboah
- Yoru'Ba' House of Worship, Inc.
All providers in Rex, GA · Licensed Practical Nurse in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.