MEDICARE: DR. DAVID KAROL GORE PHD, PC

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	1366	GA
2	103TC0700X	Clinical Psychologist	1366	GA
3	103TC2200X	Clinical Child & Adolescent Psychologist	1366	GA
4	103TF0000X	Family Psychologist	1366	GA
5	103TP2701X	Group Psychotherapy Psychologist	1366	GA

General Provider Information

NPI Number	:	1730301912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KAROL GORE PHD, PC

Provider Business Mailing Address
First Line	:	3131 E SHADOWLAWN AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2405
Country	:	US
Telephone Number	:	404-237-4300
Fax Number	:	770-594-1522

Provider Business Practice Location Address
First Line	:	3131 E SHADOWLAWN AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2405
Country	:	US
Telephone Number	:	404-237-4300
Fax Number	:	770-594-1522

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	09/11/2025

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