Provider Demographics
NPI:1285749671
Name:WEINER-JAGODA, ADINA G (PSYD)
Entity type:Individual
Prefix:DR
First Name:ADINA
Middle Name:G
Last Name:WEINER-JAGODA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 LACHONA CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3411
Mailing Address - Country:US
Mailing Address - Phone:404-325-5703
Mailing Address - Fax:
Practice Address - Street 1:181 14TH ST NE
Practice Address - Street 2:STE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3674
Practice Address - Country:US
Practice Address - Phone:404-873-6178
Practice Address - Fax:404-873-0342
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist