Active NPI
Phillip Tate Weller
- Student in an Organized Health Care Education/Training Program
- Augusta, GA
National Provider Identifier
1780339010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- License
- DN122883
- Practice address
- 1120 15TH St # Gc5110
Augusta, GA 30912-0004 - Phone
- (435) 659-4336
- NPI assigned
- Feb 15, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | DN122883 | GA | Primary |
Addresses
Primary practice location
1120 15TH St # Gc5110
Augusta, GA 30912-0004
Mailing address
1120 15TH St # Gc5110
Augusta, GA 30912-0004
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
| License | State | Type | Specialty |
|---|---|---|---|
| DN122883 | GA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667520000000",
"number": "1780339010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 15TH ST # GC5110",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 15TH ST # GC5110",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120004",
"telephone_number": "435-659-4336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLER",
"first_name": "PHILLIP",
"middle_name": "TATE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-02-15",
"last_updated": "2022-11-04",
"certification_date": "2022-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "GA",
"license": "DN122883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.