Individual
NICOLAS A. WIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
750 TOWNPARK LANE, KAISER PERMANENTE TOWNPARK MEDICAL CENTER, KENNESAW, GA 30144
(818) 375-2000
Mailing address
3495 PIEDMONT ROAD, NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305
(404) 504-5678
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
075400
GA
208VP0000X
Pain Medicine Physician
20A5558
CA
Other
Enumeration date
01/08/2007
Last updated
12/02/2016
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