Provider Demographics
NPI:1245566603
Name:JEFF WEBER, ED.D., P.C.
Entity Type:Organization
Organization Name:JEFF WEBER, ED.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFIE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-642-2725
Mailing Address - Street 1:4411 SUWANEE DAM RD
Mailing Address - Street 2:SUITE 920
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8701
Mailing Address - Country:US
Mailing Address - Phone:678-714-9590
Mailing Address - Fax:678-714-9535
Practice Address - Street 1:4411 SUWANEE DAM RD
Practice Address - Street 2:SUITE 920
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8701
Practice Address - Country:US
Practice Address - Phone:678-714-9590
Practice Address - Fax:678-714-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2094103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA007720544EMedicaid
GA66BBFHBOtherMEDICARE
GA=========Medicare UPIN