Healthcare Provider Details

I. General information

NPI: 1114049632
Provider Name (Legal Business Name): MRS. CINDY WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LACY ST NW
MARIETTA GA
30060-1112
US

IV. Provider business mailing address

2914 ASHEBROOKE DR NE
MARIETTA GA
30068-2303
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-0368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2071
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: