MEDICARE: GBR PSYCH ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1366917726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GBR PSYCH ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	675 SEMINOLE AVE NE STE 307
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-3416
Country	:	US
Telephone Number	:	678-701-9559
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 SEMINOLE AVE NE STE 307
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-3416
Country	:	US
Telephone Number	:	678-701-9559
Fax Number	:

Authorized Official
Title or Position	:	POSTDOCTORAL FELLOW
Name	:	DR. GABRIELA BEATRIZ RODRIGUEZ
Credential	:	PHD
Telephone Number	:	678-701-9559

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/11/2018

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