Provider Demographics
NPI:1578776282
Name:WEBER, CAROL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:WEBER
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 1:80 W WIEUCA RD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3205
Mailing Address - Country:US
Mailing Address - Phone:404-257-0254
Mailing Address - Fax:404-256-5707
Practice Address - Street 1:80 W WIEUCA RD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3205
Practice Address - Country:US
Practice Address - Phone:404-257-0254
Practice Address - Fax:404-256-5707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10055050OtherPSYCHOLOGIST, CHILD
GA00437159AMedicaid