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NPI Code Detail

MEDICARE: DR. DAN WIENER MD

MEDICARE: DR. DAN WIENER 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician042973GA

General Provider Information

NPI Number : 1053371757
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAN WIENER MD
Provider Business Mailing Address
First Line : PO BOX 30309
Second Line :
City : CHARLESTON
State : SC
Zip : 29417-0309
Country : US
Telephone Number : 843-554-9300
Fax Number : 843-566-8780
Provider Business Practice Location Address
First Line : 960 JOE FRANK HARRIS PKWY SE
Second Line :
City : CARTERSVILLE
State : GA
Zip : 30120-2129
Country : US
Telephone Number : 770-382-1530
Fax Number : 770-387-8198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2006
Last Update Date : 03/03/2008

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