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General NPI Number Information
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NPI Number | 1134544679
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Entity Type | Organization
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Legal Business Name | MEDICAL DERMATOLOGY SPECIALISTS,PC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 5730 GLENRIDGE DR SUITE T-100
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-6141
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Country | US
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Telephone | 404-939-9220
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Fax | 404-939-9221
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Provider Business Mailing Address
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Address Line | 5730 GLENRIDGE DR SUITE T-100
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-6141
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Country | US
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Telephone | 404-939-9220
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Fax | 404-939-9221
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JAMIE D WEISMAN
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Credential | M.D.
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Telephone | 404-939-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 50088
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License Number State | GA
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