Healthcare Provider Details

I. General information

NPI: 1457641441
Provider Name (Legal Business Name): HEATHER MONITZ WEISSMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DRIVE SUITE 120
ATLANTA GA
30328
US

IV. Provider business mailing address

5730 GLENRIDGE DR SUITE 120
ATLANTA GA
30328-6141
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-1194
  • Fax:
Mailing address:
  • Phone: 770-595-9110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number004938
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: