Provider Demographics
NPI:1922828136
Name:WESTON, ANTWONETTE MIRIAM
Entity type:Individual
Prefix:MS
First Name:ANTWONETTE
Middle Name:MIRIAM
Last Name:WESTON
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 1:1005 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-2147
Mailing Address - Country:US
Mailing Address - Phone:706-386-7506
Mailing Address - Fax:
Practice Address - Street 1:1005 GILMORE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-2147
Practice Address - Country:US
Practice Address - Phone:706-386-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-12
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care