Healthcare Provider Details

I. General information

NPI: 1740637594
Provider Name (Legal Business Name): MICHAEL ADELBERT WEBBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 HIGHWAY 34 E STE 2200
NEWNAN GA
30265-3190
US

IV. Provider business mailing address

1755 HIGHWAY 34 E STE 2200
NEWNAN GA
30265-3190
US

V. Phone/Fax

Practice location:
  • Phone: 770-502-2175
  • Fax: 770-254-7837
Mailing address:
  • Phone: 770-502-2175
  • Fax: 770-254-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number92343
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number92343
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: