Provider Demographics
NPI:1174020283
Name:HEINZELMANN-WEISBAUM, MORGAN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:MICHELLE
Last Name:HEINZELMANN-WEISBAUM
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 1:1680 HARTFORD GLN NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2152
Mailing Address - Country:US
Mailing Address - Phone:803-479-4036
Mailing Address - Fax:
Practice Address - Street 1:21 ORTHO LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2315
Practice Address - Country:US
Practice Address - Phone:047-783-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA968032084P2900X
CAA1755882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine