Provider Demographics
NPI:1619200672
Name:WEINISCH, ERIN KIM (PA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KIM
Last Name:WEINISCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:WEINISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2701 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5918
Mailing Address - Country:US
Mailing Address - Phone:404-501-5422
Mailing Address - Fax:404-501-1771
Practice Address - Street 1:2701 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-501-5422
Practice Address - Fax:404-501-1771
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006109363AM0700X, 363A00000X
FLPA9105075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001428700Medicaid
GA003109610FMedicaid
GA202I972249Medicare PIN
GA20297I0269Medicare PIN
FLCL252ZMedicare PIN