Healthcare Provider Details

I. General information

NPI: 1386936839
Provider Name (Legal Business Name): WESTON THOMAS WAXWEILER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PROFESSIONAL PARK DR
CUMMING GA
30040-2381
US

IV. Provider business mailing address

59 TIPTON DR
DAHLONEGA GA
30533-1603
US

V. Phone/Fax

Practice location:
  • Phone: 770-800-3455
  • Fax: 770-284-8380
Mailing address:
  • Phone: 770-800-3455
  • Fax: 770-450-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number073880
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: