Provider Demographics
NPI:1376237123
Name:WEISMAN, STEPHANIE (CSFA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 OLNEY FALLS DR
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-3417
Mailing Address - Country:US
Mailing Address - Phone:678-772-5173
Mailing Address - Fax:
Practice Address - Street 1:2532 OLNEY FALLS DR
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3417
Practice Address - Country:US
Practice Address - Phone:678-772-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical