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Organization

NORTHSIDE DERMATOLOGY ASSOCIATES, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. STEWART E WIEGAND M.D. (DOCTOR/OWNER)
(404) 256-5611
Entity
Organization

Contact information

Practice address
755 MOUNT VERNON HWY, SUITE 110, ATLANTA, GA 30328-4274
(404) 256-9692
(404) 256-9404
Mailing address
755 MOUNT VERNON HWY, SUITE 110, ATLANTA, GA 30328-4274
(404) 256-9692
(404) 256-9404

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
012988
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00176481C
GA
01
CM5399
RAILROAD MEDICARE
GA
Enumeration date
11/15/2007
Last updated
12/05/2007
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