Healthcare Provider Details

I. General information

NPI: 1225964489
Provider Name (Legal Business Name): ANTHONY GATTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 COLUMBIA RD
MARTINEZ GA
30907-5400
US

IV. Provider business mailing address

4145 COLUMBIA RD
MARTINEZ GA
30907-5400
US

V. Phone/Fax

Practice location:
  • Phone: 706-869-7373
  • Fax:
Mailing address:
  • Phone: 706-869-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: