Provider Demographics
NPI:1629222674
Name:WEEKLEY, CHARLES KIRVEN III (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KIRVEN
Last Name:WEEKLEY
Suffix:III
Gender:M
Credentials:PHD
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Mailing Address - Street 1:752 HOLCOMB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1325
Mailing Address - Country:US
Mailing Address - Phone:770-441-9244
Mailing Address - Fax:770-441-9334
Practice Address - Street 1:752 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1325
Practice Address - Country:US
Practice Address - Phone:770-441-9244
Practice Address - Fax:770-441-9334
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA1852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDSDMedicare PIN