Provider Demographics
NPI:1548695588
Name:WEAVER, ABRAHAM JAMES (APRN NP-C)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:JAMES
Last Name:WEAVER
Suffix:
Gender:M
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 RIDGE MEDICAL PLAZA RD STE A
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-4531
Mailing Address - Country:US
Mailing Address - Phone:803-637-3146
Mailing Address - Fax:803-637-6597
Practice Address - Street 1:155 RIDGE MEDICAL PLAZA RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4531
Practice Address - Country:US
Practice Address - Phone:803-637-3146
Practice Address - Fax:803-637-6597
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195004363LF0000X
SC19746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily