Provider Demographics
NPI:1659457380
Name:WEINER, NANCY CANTER (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CANTER
Last Name:WEINER
Suffix:
Gender:F
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:PO BOX 725367
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-2367
Mailing Address - Country:US
Mailing Address - Phone:404-350-8941
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FERRY RD STE 270
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1637
Practice Address - Country:US
Practice Address - Phone:404-350-8941
Practice Address - Fax:404-355-1827
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAD33749207W00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F16489Medicare UPIN
GA13BDBWSMedicare ID - Type Unspecified