Individual provider Active NPI

Santresa Weldon

  • Specialist
  • Warner Robins, GA
National Provider Identifier
1629423751
Registry record updated Apr 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
CO087817 Issued in GA
Practice address
105 Renoir LN
Warner Robins, GA 31088-6321
Phone
(478) 971-7807
NPI assigned
Apr 26, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X CO087817 GA Primary

Addresses

Primary practice location

105 Renoir LN
Warner Robins, GA 31088-6321

Mailing address

105 Renoir LN
Warner Robins, GA 31088-6321
Phone (478) 971-7807

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CO087817GAMDSpecialist

NPI Registry JSON

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

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461628800000",
    "number": "1629423751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 RENOIR LN",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310886321",
            "telephone_number": "478-971-7807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 RENOIR LN",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310886321",
            "telephone_number": "478-971-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELDON",
        "first_name": "SANTRESA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-26",
        "last_updated": "2016-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "CO087817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; 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.