MEDICARE: PHILIP S WEISS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	038398	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	499492	OTHER	BLUE CROSS BLUE SHIELD
2	5033138	OTHER	AETNA CAPITATED
3	040470	OTHER	GREAT WEST
4	569351	OTHER	AETNA
5	691304	OTHER	CIGNA HEALTHCARE

General Provider Information

NPI Number	:	1043275308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP S WEISS MD

Provider Business Mailing Address
First Line	:	1100 LAKE HEARN DR NE
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30342-1523
Country	:	US
Telephone Number	:	404-256-3178
Fax Number	:	404-256-3583

Provider Business Practice Location Address
First Line	:	1100 LAKE HEARN DR NE
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30342-1523
Country	:	US
Telephone Number	:	404-256-3178
Fax Number	:	404-256-3583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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Directions to “ PHILIP S WEISS MD” Practice Location

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