Healthcare Provider Details

I. General information

NPI: 1861654782
Provider Name (Legal Business Name): MICHAEL ADAM WEILER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 LANEY WALKER BLVD
AUGUSTA GA
30912-0002
US

IV. Provider business mailing address

1116 COBB ST
AUGUSTA GA
30904-4130
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2251
  • Fax:
Mailing address:
  • Phone: 706-736-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: