MEDICARE: PAMELA ABERCROMBIE WEIGANDT 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	207L00000X	Anesthesiology Physician	51609	GA

General Provider Information

NPI Number	:	1144218843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA ABERCROMBIE WEIGANDT MD

Provider Business Mailing Address
First Line	:	200 MANSELL CT E
Second Line	:	ATTN: CREDENTIALING DEPT, SUITE 105
City	:	ROSWELL
State	:	GA
Zip	:	30076-4856
Country	:	US
Telephone Number	:	770-645-9181
Fax Number	:	770-645-8455

Provider Business Practice Location Address
First Line	:	993 JOHNSON FERRY RD NE
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30342-1620
Country	:	US
Telephone Number	:	678-574-0943
Fax Number	:	678-574-0943

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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