Healthcare Provider Details

I. General information

NPI: 1871370148
Provider Name (Legal Business Name): JOSH GUNN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 LASSITER RD, BLDG C, STE 200
MARIETTA GA
30062
US

IV. Provider business mailing address

4204 SUMMIT WAY
MARIETTA GA
30066-2366
US

V. Phone/Fax

Practice location:
  • Phone: 470-531-5984
  • Fax:
Mailing address:
  • Phone: 770-864-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: