Provider Demographics
NPI:1528086097
Name:HANEY-WEAVER, JERRIE CAROLINE (MD)
Entity type:Individual
Prefix:DR
First Name:JERRIE
Middle Name:CAROLINE
Last Name:HANEY-WEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH STREET
Mailing Address - Street 2:SUITE 509
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1853
Mailing Address - Country:US
Mailing Address - Phone:865-524-3208
Mailing Address - Fax:865-522-4322
Practice Address - Street 1:501 19TH STREET
Practice Address - Street 2:SUITE 509
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1853
Practice Address - Country:US
Practice Address - Phone:865-524-3208
Practice Address - Fax:865-522-4322
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40791207VX0000X
TN40791207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
4131926OtherBLUE CROSS BLUE SHIELD
TN1154546927OtherGROUP NPI NUMBER
TN3832868Medicaid
TNI70942Medicare UPIN
TN3832868Medicaid
4131926OtherBLUE CROSS BLUE SHIELD