Provider Demographics
NPI:1336358688
Name:WEINSTEIN, JAY (PHD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 W MAIN ST STE 25A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3075
Mailing Address - Country:US
Mailing Address - Phone:770-982-2352
Mailing Address - Fax:770-982-8848
Practice Address - Street 1:2795 W MAIN ST STE 25A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3075
Practice Address - Country:US
Practice Address - Phone:770-982-2352
Practice Address - Fax:770-982-8848
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2257103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000915582AMedicaid
GA000915582AMedicaid
GA68BBGLNMedicare PIN