Healthcare Provider Details

I. General information

NPI: 1669424966
Provider Name (Legal Business Name): ALAN J. GOTTLIEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7823 SPIVEY STATION BLVD STE 310
JONESBORO GA
30236
US

IV. Provider business mailing address

6600 PEACHTREE DUNWOODY RD STE 325
ATLANTA GA
30328-6773
US

V. Phone/Fax

Practice location:
  • Phone: 770-996-1122
  • Fax: 770-907-1429
Mailing address:
  • Phone: 404-876-1906
  • Fax: 404-256-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number27554
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: