Healthcare Provider Details

I. General information

NPI: 1366917726
Provider Name (Legal Business Name): GBR PSYCH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 SEMINOLE AVE NE STE 307
ATLANTA GA
30307-3416
US

IV. Provider business mailing address

675 SEMINOLE AVE NE STE 307
ATLANTA GA
30307-3416
US

V. Phone/Fax

Practice location:
  • Phone: 678-701-9559
  • Fax:
Mailing address:
  • Phone: 678-701-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIELA BEATRIZ RODRIGUEZ
Title or Position: POSTDOCTORAL FELLOW
Credential: PHD
Phone: 678-701-9559