Provider Demographics
NPI:1083837827
Name:BREINER, JERI (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:
Last Name:BREINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GLENRIDGE DR NE
Mailing Address - Street 2:BLDG. 3, SUITE 101C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:770-933-0220
Mailing Address - Fax:404-255-9254
Practice Address - Street 1:6075 ROSWELL RD NE
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4008
Practice Address - Country:US
Practice Address - Phone:770-933-0220
Practice Address - Fax:404-255-9254
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001117103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-2374786OtherEIN