MEDICARE: MARK J WEINER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	33748	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180010817	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184616047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J WEINER M.D.

Provider Business Mailing Address
First Line	:	800 MOUNT VERNON HWY NE STE 120
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4293
Country	:	US
Telephone Number	:	770-720-4041
Fax Number	:	770-479-4857

Provider Business Practice Location Address
First Line	:	100 RIVER POINTE PKWY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2865
Country	:	US
Telephone Number	:	770-720-4041
Fax Number	:	770-479-4857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	12/12/2025

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