Provider Demographics
NPI:1336180553
Name:WEINMAN, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WEINMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 OOSTANAULA DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3572
Mailing Address - Country:US
Mailing Address - Phone:616-450-6453
Mailing Address - Fax:
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8016
Practice Address - Country:US
Practice Address - Phone:678-786-7430
Practice Address - Fax:678-786-7431
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081275207Y00000X
GA83729207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M74460346Medicare PIN
H06103Medicare UPIN