Basic Information
| Provider Information | |||||||||
| NPI: | 1629398979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEINBERG | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 PHILIP BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708225560 | ||||||||
| FaxNumber: | 7708224989 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 PHILIP BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708225560 | ||||||||
| FaxNumber: | 7708224989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2010 | ||||||||
| LastUpdateDate: | 02/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 245253 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 18508 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 075026 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.