Provider Demographics
NPI:1649228180
Name:WEIL, CRAIG EVAN (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:EVAN
Last Name:WEIL
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 1:1211 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2722
Mailing Address - Country:US
Mailing Address - Phone:770-565-0011
Mailing Address - Fax:770-565-9866
Practice Address - Street 1:1211 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-565-0011
Practice Address - Fax:770-565-9866
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA41774386CMedicare ID - Type Unspecified
GAD31277Medicare UPIN