MEDICARE: WEIGHTWISE MEDICAL CLINIC P.C.

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1407736556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEIGHTWISE MEDICAL CLINIC P.C.

Provider Business Mailing Address
First Line	:	8045 TARA BLVD STE 299
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3294
Country	:	US
Telephone Number	:	800-577-8613
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 PACES FERRY RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-5703
Country	:	US
Telephone Number	:	229-427-1009
Fax Number	:

Authorized Official
Title or Position	:	CEO, OWNER
Name	:	MS. ALICIA LAVETTE WATSON
Credential	:	NURSE PRACTITIONER
Telephone Number	:	470-593-9632

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	02/25/2026

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