Healthcare Provider Details

I. General information

NPI: 1588229439
Provider Name (Legal Business Name): RYAN C WEEGENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HOWARD FARM DR STE 200
CUMMING GA
30041-6081
US

IV. Provider business mailing address

2000 HOWARD FARM DR STE 200
CUMMING GA
30041-6081
US

V. Phone/Fax

Practice location:
  • Phone: 770-758-8964
  • Fax: 770-292-6535
Mailing address:
  • Phone: 770-758-8964
  • Fax: 770-292-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number111079
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: