Provider Demographics
NPI:1033131610
Name:WEISMAN, JAMIE D (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:D
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 GLENRIDGE DR
Mailing Address - Street 2:SUITE T-100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6141
Mailing Address - Country:US
Mailing Address - Phone:404-939-9220
Mailing Address - Fax:404-939-9221
Practice Address - Street 1:5730 GLENRIDGE DR
Practice Address - Street 2:SUITE T-100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6141
Practice Address - Country:US
Practice Address - Phone:404-939-9220
Practice Address - Fax:404-939-9221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA070016848OtherMEDICARE RR
GA07BBSSTOtherMEDICARE ID
GA07BBSSTOtherMEDICARE ID