Healthcare Provider Details

I. General information

NPI: 1386836583
Provider Name (Legal Business Name): DAWIT WELDEMICHAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SHORTER AVE NW STE 104
ROME GA
30165-4256
US

IV. Provider business mailing address

420 E 2ND AVE STE 103
ROME GA
30161-3210
US

V. Phone/Fax

Practice location:
  • Phone: 706-232-5650
  • Fax:
Mailing address:
  • Phone: 706-509-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number075710
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number075710
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: