Healthcare Provider Details

I. General information

NPI: 1700611464
Provider Name (Legal Business Name): NANCY MARIE GIMBEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW
MARIETTA GA
30060-1134
US

IV. Provider business mailing address

951 GLENWOOD AVE SE UNIT 2802
ATLANTA GA
30316-1893
US

V. Phone/Fax

Practice location:
  • Phone: 770-528-0260
  • Fax:
Mailing address:
  • Phone: 404-580-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004821
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: