Individual provider Active NPI

Jay Weinstein, PH.D.

  • Clinical Neuropsychologist
  • Snellville, GA
National Provider Identifier
1336358688
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
2257 Issued in GA
Practice address
2795 W Main St Ste 25a
Snellville, GA 30078-3075
Phone
(770) 982-2352
Fax
(770) 982-8848
NPI assigned
May 22, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 2257 GA Primary

Addresses

Primary practice location

2795 W Main St Ste 25a
Snellville, GA 30078-3075

Mailing address

2795 W Main St Ste 25a
Snellville, GA 30078-3075
Phone (770) 982-2352

Other identifiers 1

IdentifierTypeStateIssuer
000915582AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050103000134 GA Practitioner - Clinical Psychologist 6709854243 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanta Clinical Health GroupGroup PAC ID 5991773434, 2 clinicians

Practice addresses (Care Compare)

2795 W Main St
Suite 25a
Snellville, GA 30078-3075
Phone (770) 982-2352

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
575GAMDPastoral Counselor
2257GAMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanta Clinical Health Group Clinical Neuropsychologist CurrentSince Mar 30, 2004 Accepting new patients

Locations

5470 Meridian Mark Rd
Sandy Springs, GA 30342
Phone (404) 218-4912

2160 Fountain Dr
Ste 200
Snellville, GA 30078
Phone (770) 982-1111

2795 W Main St
Ste 25A
Snellville, GA 30078
Phone (770) 982-2352

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1336358688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2795 W MAIN ST STE 25A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783075",
            "telephone_number": "770-982-2352",
            "fax_number": "770-982-8848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2795 W MAIN ST STE 25A",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783075",
            "telephone_number": "770-982-2352",
            "fax_number": "770-982-8848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINSTEIN",
        "first_name": "JAY",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "GA",
            "license": "2257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000915582A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

Verify at the official NPI Registry.