Healthcare Provider Details

I. General information

NPI: 1174020283
Provider Name (Legal Business Name): MORGAN MICHELLE HEINZELMANN-WEISBAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 08/15/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ORTHO LN
ATLANTA GA
30329-2315
US

IV. Provider business mailing address

1680 HARTFORD GLN NE
BROOKHAVEN GA
30319-2152
US

V. Phone/Fax

Practice location:
  • Phone: 47-783-3504
  • Fax:
Mailing address:
  • Phone: 803-479-4036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number96803
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: