MEDICARE: DR. JOHN GOSS HERBERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	10566	GA

General Provider Information

NPI Number	:	1053658989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GOSS HERBERT M.D.

Provider Business Mailing Address
First Line	:	3400 PEACHTREE RD NE
Second Line	:	LENOX TOWERS, SUITE 915
City	:	ATLANTA
State	:	GA
Zip	:	30326-1170
Country	:	US
Telephone Number	:	404-261-1373
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 PEACHTREE RD NE
Second Line	:	LENOX TOWERS, SUITE 915
City	:	ATLANTA
State	:	GA
Zip	:	30326-1170
Country	:	US
Telephone Number	:	404-261-1373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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