Provider Demographics
NPI:1861479925
Name:WEISMAN, NANCY C (PHD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:C
Last Name:WEISMAN
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 1:820 EDGEWATER TR
Mailing Address - Street 2:
Mailing Address - City:SANOY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2825
Mailing Address - Country:US
Mailing Address - Phone:404-324-1223
Mailing Address - Fax:404-256-9062
Practice Address - Street 1:820 EDGEWATER TR
Practice Address - Street 2:
Practice Address - City:SANOY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2825
Practice Address - Country:US
Practice Address - Phone:404-324-1223
Practice Address - Fax:404-256-9062
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001914103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00662769AMedicaid
68BBDJLMedicare ID - Type Unspecified