=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285841932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | G. PAT STOGNER LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1827 POWERS FERRY RD SE BUILDING 24, SUITE 300
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-5621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-818-0068
-----------------------------------------------------
Fax | 770-818-0068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 760 KENNESAW DUE WEST RD NW
-----------------------------------------------------
City | KENNESAW
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30152-6939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-422-0895
-----------------------------------------------------
Fax | 770-818-0068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000347
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------