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General NPI Number Information
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NPI Number | 1174020283
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Entity Type | Individual
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Provider Name | MORGAN MICHELLE HEINZELMANN-WEISBAUM MD
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Gender | Female
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 21 ORTHO LN
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City | ATLANTA
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State | GA
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Zip | 30329-2315
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Country | US
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Telephone | 47-783-3504
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Fax |
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Provider Business Mailing Address
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Address Line | 1680 HARTFORD GLN NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-2152
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Country | US
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Telephone | 803-479-4036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number | 96803
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License Number State | GA
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