Healthcare Provider Details

I. General information

NPI: 1447235387
Provider Name (Legal Business Name): PAUL B WEINBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 PROFESSIONAL DR SUITE 350
LAWRENCEVILLE GA
30046-3367
US

IV. Provider business mailing address

631 PROFESSIONAL DR SUITE 350
LAWRENCEVILLE GA
30046-3367
US

V. Phone/Fax

Practice location:
  • Phone: 770-995-0630
  • Fax: 770-995-1555
Mailing address:
  • Phone: 770-995-0630
  • Fax: 678-942-5984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number23244
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number23244
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: