Provider Demographics
NPI:1033281779
Name:WEITZMAN-SWAIN, ANN (PHD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WEITZMAN-SWAIN
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 1:1 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:706-552-0450
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:706-552-0450
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002033103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00717318BMedicaid
GA00717318BMedicaid