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General NPI Number Information
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NPI Number | 1457898371
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Entity Type | Organization
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Legal Business Name | TAMARA WEISS, M.D., LLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 1772 CENTURY BLVD NE STE A
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City | ATLANTA
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State | GA
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Zip | 30345-3396
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Country | US
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Telephone | 404-474-7021
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Fax |
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Provider Business Mailing Address
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Address Line | 501 PULLIAM ST SW SUITE 407
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City | ATLANTA
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State | GA
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Zip | 30312-2755
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Country | US
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Telephone | 404-474-7021
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAMARA E WEISS
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Credential | MD
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Telephone | 404-474-7021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 059789
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 059789
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License Number State | GA
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