Provider Demographics
NPI:1598844862
Name:WEIGEL, NOEL DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:DOUGLAS
Last Name:WEIGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FAIRVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2547
Mailing Address - Country:US
Mailing Address - Phone:478-272-6150
Mailing Address - Fax:478-272-4903
Practice Address - Street 1:200 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2547
Practice Address - Country:US
Practice Address - Phone:478-272-6150
Practice Address - Fax:478-272-4903
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA41385208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000700169BMedicaid
GAG26917Medicare UPIN
GA000700169BMedicaid