Provider Demographics
NPI:1447235387
Name:WEINBERG, PAUL B (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:B
Last Name:WEINBERG
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 1:631 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3367
Mailing Address - Country:US
Mailing Address - Phone:770-995-0630
Mailing Address - Fax:678-942-5984
Practice Address - Street 1:631 PROFESSIONAL DR
Practice Address - Street 2:SUITE 350
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3367
Practice Address - Country:US
Practice Address - Phone:770-995-0630
Practice Address - Fax:770-995-1555
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23244207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00322374AMedicaid
AL581586758Medicaid
AL581586758Medicaid