Healthcare Provider Details

I. General information

NPI: 1245361237
Provider Name (Legal Business Name): PATRICIA E. GORE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 HIGHWAY 92 STE 120
WOODSTOCK GA
30189-5235
US

IV. Provider business mailing address

7450 HIGHWAY 92 STE 120
WOODSTOCK GA
30189-5235
US

V. Phone/Fax

Practice location:
  • Phone: 770-924-9700
  • Fax: 770-926-0690
Mailing address:
  • Phone: 770-924-9700
  • Fax: 770-926-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY002161
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: