Healthcare Provider Details

I. General information

NPI: 1669410965
Provider Name (Legal Business Name): EDWARD C WEISS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON ROAD NE, MAILSTOP V24-5 CDC/NCSTLTPHIW/DWD/ELWB/FRST
ATLANTA GA
30329-4018
US

IV. Provider business mailing address

710 TROWGATE CT
SANDY SPRINGS GA
30350-6888
US

V. Phone/Fax

Practice location:
  • Phone: 770-488-2624
  • Fax:
Mailing address:
  • Phone: 404-964-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number57514
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57514
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: