Provider Demographics
NPI:1235128323
Name:WEAVER, THOMAS L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4994 LOWER ROSWELL RD
Mailing Address - Street 2:SUITE #29
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4332
Mailing Address - Country:US
Mailing Address - Phone:404-433-2344
Mailing Address - Fax:
Practice Address - Street 1:4994 LOWER ROSWELL RD
Practice Address - Street 2:SUITE #29
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4332
Practice Address - Country:US
Practice Address - Phone:404-433-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002766103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical