Healthcare Provider Details

I. General information

NPI: 1013001130
Provider Name (Legal Business Name): ALAN MARC WEINBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLENLAKE PKWY DEPT OF BEHAVIORAL HEALTH
ATLANTA GA
30328
US

IV. Provider business mailing address

3495 PIEDMONT ROAD, NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1736
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax: 770-389-3030
Mailing address:
  • Phone: 404-364-7070
  • Fax: 770-389-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number035785
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number035785
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number035785
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: