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General NPI Number Information
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NPI Number | 1033394820
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Entity Type | Organization
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Legal Business Name | MARK GILSON PHD PC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 1772 CENTURY BOULEVARD, NE
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City | ATLANTA
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State | GA
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Zip | 30345-3396
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Country | US
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Telephone | 404-248-1159
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Fax | 404-248-9776
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Provider Business Mailing Address
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Address Line | 1772 CENTURY BLVD NE
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City | ATLANTA
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State | GA
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Zip | 30345-3396
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Country | US
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Telephone | 404-248-1159
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Fax | 404-248-9776
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MARK GILSON
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Credential | PH.D.
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Telephone | 404-248-1159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 1022
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License Number State | GA
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