Provider Demographics
NPI:1265582357
Name:WEAVER, MARGARET O (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:O
Last Name:WEAVER
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 1:9350 CARILLON CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7411
Mailing Address - Country:US
Mailing Address - Phone:770-603-7847
Mailing Address - Fax:770-474-3738
Practice Address - Street 1:275 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7349
Practice Address - Country:US
Practice Address - Phone:770-474-8400
Practice Address - Fax:770-474-3738
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001227103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00440635CMedicaid
GAS35355Medicare UPIN
GA68BBCGZMedicare ID - Type Unspecified