Healthcare Provider Details

I. General information

NPI: 1902664246
Provider Name (Legal Business Name): MICHAEL GERALD CURTIS JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 MALVERN BLVD
STONE MOUNTAIN GA
30087-5423
US

IV. Provider business mailing address

718 MALVERN BLVD
STONE MOUNTAIN GA
30087-5423
US

V. Phone/Fax

Practice location:
  • Phone: 702-563-7486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002013
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: