Healthcare Provider Details

I. General information

NPI: 1497043889
Provider Name (Legal Business Name): HARMON SAUL WEITZMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 W JOHNS CROSSING C/O ESA-ANESTHESIOLOGY
JOHNS CREEK GA
30097-1530
US

IV. Provider business mailing address

ESA ANESTHESIOLOGY PO BOX 12398
ATLANTA GA
30368-0398
US

V. Phone/Fax

Practice location:
  • Phone: 404-788-7088
  • Fax:
Mailing address:
  • Phone: 404-778-7088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN170857
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: