Provider Demographics
NPI:1295807816
Name:EATING DISORDERS RECOVERY CENTER
Entity type:Organization
Organization Name:EATING DISORDERS RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEITZMAN-SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-552-0450
Mailing Address - Street 1:1 HUNTINGTON RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7204
Mailing Address - Country:US
Mailing Address - Phone:706-552-0450
Mailing Address - Fax:
Practice Address - Street 1:1 HUNTINGTON RD
Practice Address - Street 2:SUITE 801
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7204
Practice Address - Country:US
Practice Address - Phone:706-552-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00717318BMedicaid
GA00717318BMedicaid