Provider Demographics
NPI:1508187519
Name:WEINER, THOMAS (MBBS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:WEINER
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 W BROAD ST STE A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2511
Mailing Address - Country:US
Mailing Address - Phone:706-850-6134
Mailing Address - Fax:706-850-6318
Practice Address - Street 1:855 W BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2511
Practice Address - Country:US
Practice Address - Phone:706-850-6134
Practice Address - Fax:706-850-6318
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT198022207Q00000X
GA072846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine