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General NPI Number Information
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NPI Number | 1962148965
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Entity Type | Individual
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Provider Name | KORRINE MARIE WEIDMAN
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Gender | Female
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 5885 GLENRIDGE DR UNIT 100
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5512
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Country | US
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Telephone | 678-321-8546
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Fax |
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Provider Business Mailing Address
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Address Line | 415 PADDOCK HILL CT
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City | ROSWELL
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State | GA
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Zip | 30075-2150
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Country | US
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Telephone | 845-399-5339
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NCO-000001
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License Number State | GA
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