| NPI | 1275866527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERALD M GOTTLIEB Psychologist 912-224-5841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY002692) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2021-10-29 |