Provider Demographics
NPI:1356374284
Name:WEDDINGTON, DEBORAH L
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:WEDDINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-578-4379
Mailing Address - Fax:423-578-4369
Practice Address - Street 1:1315 EUCLID AVE
Practice Address - Street 2:SUITE E17
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3834
Practice Address - Country:US
Practice Address - Phone:276-669-8707
Practice Address - Fax:276-669-9312
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058813207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
493860OtherMEDICARE GROUP NUMBER
493860OtherMEDICARE GROUP NUMBER