Healthcare Provider Details

I. General information

NPI: 1033131610
Provider Name (Legal Business Name): JAMIE D WEISMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DR SUITE T-100
ATLANTA GA
30328-6141
US

IV. Provider business mailing address

5730 GLENRIDGE DR SUITE T-100
ATLANTA GA
30328-6141
US

V. Phone/Fax

Practice location:
  • Phone: 404-939-9220
  • Fax: 404-939-9221
Mailing address:
  • Phone: 404-939-9220
  • Fax: 404-939-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number50088
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number50088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: