Healthcare Provider Details

I. General information

NPI: 1619996907
Provider Name (Legal Business Name): NORTH GEORGIA INTERNAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 BUCKHEAD XING SUITE E
WOODSTOCK GA
30189-4254
US

IV. Provider business mailing address

1192 BUCKHEAD XING SUITE E
WOODSTOCK GA
30189-4254
US

V. Phone/Fax

Practice location:
  • Phone: 678-494-4450
  • Fax: 678-494-6265
Mailing address:
  • Phone: 678-494-4450
  • Fax: 678-494-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRAM WIESKOPF
Title or Position: PRESIDENT
Credential: MD
Phone: 678-494-4450