Provider Demographics
NPI:1912996422
Name:WEISS, LAWRENCE STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:STEVEN
Last Name:WEISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3901 ROSWELL RD
Mailing Address - Street 2:STE 225
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8816
Mailing Address - Country:US
Mailing Address - Phone:770-971-1533
Mailing Address - Fax:770-971-4846
Practice Address - Street 1:3901 ROSWELL RD
Practice Address - Street 2:STE 225
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8816
Practice Address - Country:US
Practice Address - Phone:770-971-1533
Practice Address - Fax:770-971-4846
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044863207Y00000X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA40013588OtherRAILROAD MEDICARE
GA52637226OtherBCBS OF GEORGIA
GA21159705622OtherBEECHSTREET
GA0308854OtherCIGNA
GA04BDVQMedicare ID - Type Unspecified
GA52637226OtherBCBS OF GEORGIA