Healthcare Provider Details

I. General information

NPI: 1336180553
Provider Name (Legal Business Name): ERIC WEINMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 NORTHSIDE CHEROKEE BLVD
CANTON GA
30115-8016
US

IV. Provider business mailing address

2502 OOSTANAULA DR NE
BROOKHAVEN GA
30319-3572
US

V. Phone/Fax

Practice location:
  • Phone: 678-786-7430
  • Fax: 678-786-7431
Mailing address:
  • Phone: 616-450-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301081275
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number83729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: