Provider Demographics
NPI:1194757492
Name:ATLANTA CLINICAL HEALTH GROUP
Entity type:Organization
Organization Name:ATLANTA CLINICAL HEALTH GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:770-982-2352
Mailing Address - Street 1:2795 W MAIN ST STE 25A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3075
Mailing Address - Country:US
Mailing Address - Phone:770-982-2352
Mailing Address - Fax:770-982-8848
Practice Address - Street 1:2795 W MAIN ST STE 25A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3075
Practice Address - Country:US
Practice Address - Phone:770-982-2352
Practice Address - Fax:770-982-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP6686Medicare ID - Type Unspecified