Provider Demographics
NPI:1386997765
Name:WEATHERSTONE MEDICAL CARE LLC.
Entity type:Organization
Organization Name:WEATHERSTONE MEDICAL CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-675-6025
Mailing Address - Street 1:3203 S CHEROKEE LN
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4461
Mailing Address - Country:US
Mailing Address - Phone:770-675-6025
Mailing Address - Fax:770-675-7814
Practice Address - Street 1:3203 S CHEROKEE LN
Practice Address - Street 2:SUITE 220
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4461
Practice Address - Country:US
Practice Address - Phone:770-675-6025
Practice Address - Fax:770-675-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA186997325CMedicaid
GAH99168Medicare UPIN
GA186997325CMedicaid