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NPI Code Detail

MEDICARE: DR. CORTNEY WEISSGLASS PSYD

MEDICARE: DR. CORTNEY WEISSGLASS PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist091766NY
2103T00000XPsychologistPSY003784GA
3103T00000XPsychologist4506NC

General Provider Information

NPI Number : 1790037281
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORTNEY WEISSGLASS PSYD
Provider Business Mailing Address
First Line : 1059 W NANCY CREEK DR NE
Second Line :
City : BROOKHAVEN
State : GA
Zip : 30319-1646
Country : US
Telephone Number : 404-913-4824
Fax Number :
Provider Business Practice Location Address
First Line : 25 LENOX POINTE NE STE B
Second Line :
City : ATLANTA
State : GA
Zip : 30324-7420
Country : US
Telephone Number : 404-913-4824
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2012
Last Update Date : 05/12/2015

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