Healthcare Provider Details

I. General information

NPI: 1770589582
Provider Name (Legal Business Name): ROBERT M WEINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 HOSPITAL PKWY SUITE 111
JOHNS CREEK GA
30097-1549
US

IV. Provider business mailing address

6335 HOSPITAL PKWY SUITE 111
JOHNS CREEK GA
30097-1549
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8311
  • Fax: 770-495-1585
Mailing address:
  • Phone: 404-778-8311
  • Fax: 770-495-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number174859-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number59939
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: