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General NPI Number Information
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NPI Number | 1194757492
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Entity Type | Organization
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Legal Business Name | ATLANTA CLINICAL HEALTH GROUP
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 03/25/2011
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Provider Practice Location Address
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Address Line | 2795 W MAIN ST STE 25A
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City | SNELLVILLE
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State | GA
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Zip | 30078-3075
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Country | US
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Telephone | 770-982-2352
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Fax | 770-982-8848
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Provider Business Mailing Address
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Address Line | 2795 W MAIN ST STE 25A
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City | SNELLVILLE
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State | GA
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Zip | 30078-3075
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Country | US
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Telephone | 770-982-2352
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Fax | 770-982-8848
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. JAY ALAN WEINSTEIN
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Credential | PH D
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Telephone | 770-982-2352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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