Provider Demographics
NPI:1497784763
Name:WEITZ, FREDRIC IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:IRA
Last Name:WEITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 WATERFORD GREEN CLOSE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2920
Mailing Address - Country:US
Mailing Address - Phone:770-649-7734
Mailing Address - Fax:
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL DEPT OF ANESTHESIOLOGY
Practice Address - Street 2:1364 CLIFTON RD. N.E.
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-778-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023129207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology