Provider Demographics
NPI:1760578678
Name:WEISS, BETSY GARRETT (PA-C)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:GARRETT
Last Name:WEISS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TREE LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2016
Mailing Address - Country:US
Mailing Address - Phone:770-972-6464
Mailing Address - Fax:770-978-4819
Practice Address - Street 1:1800 TREE LN
Practice Address - Street 2:SUITE 300
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2016
Practice Address - Country:US
Practice Address - Phone:770-972-6464
Practice Address - Fax:770-978-4819
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P57530Medicare UPIN