MEDICARE: DR. STEWART E WIEGAND MD

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	207N00000X	Dermatology Physician	012988	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CM5399	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1477544138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEWART E WIEGAND MD

Provider Business Mailing Address
First Line	:	401 S MAIN ST
Second Line	:	SUITE A2
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-1974
Country	:	US
Telephone Number	:	404-256-9692
Fax Number	:	404-256-9404

Provider Business Practice Location Address
First Line	:	755 MT VERNON HIGHWAY
Second Line	:	SUITE 110
City	:	ATLANTA
State	:	GA
Zip	:	30328-4276
Country	:	US
Telephone Number	:	404-256-9692
Fax Number	:	404-256-9404

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	04/08/2014

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