Doctor Name: | MEREDITH WEITNAUER |
NPI Number: | 1114393915 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 005988 |
Business Practice Address: | 10050 Medlock Bridge Rd Johns Creek, GA - 300974427 |
Business Phone Number: | 6789838993 |
Business Fax Number: | 8006903302 |
Mailing Address: | 3500 River Heights Xing Se, MARIETTA |
State: | GA |
Postal Code: | 300674894 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/15/2015 |
NPI Last Update Date: | 08/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 005988 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |