Provider Demographics
NPI:1992856512
Name:WEILENMAN, JANE FORTSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:FORTSON
Last Name:WEILENMAN
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 1:400 JOHNNY MERCER BLVD STE G
Mailing Address - Street 2:PO BOX 30633
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2166
Mailing Address - Country:US
Mailing Address - Phone:912-667-7716
Mailing Address - Fax:912-898-7717
Practice Address - Street 1:400 JOHNNY MERCER BLVD
Practice Address - Street 2:STE G
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2144
Practice Address - Country:US
Practice Address - Phone:912-667-7716
Practice Address - Fax:912-898-7717
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002596103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist