Dr. Edward Marvin Gotlieb
Adolescent Medicine
5405 Memorial Dr Building D
Stone Mountain
, Georgia 30083-3234
Dr. Edward Marvin Gotlieb
Adolescent Medicine
5405 Memorial Dr Building D
Stone Mountain
, Georgia 30083-3234
(404) 297-8753
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About
Features
Specialties
- Adolescent Medicine
Languages spoken
- English
Location
First Address
- Dr. Edward Marvin Gotlieb
- 5405 Memorial Dr Building D
- Stone Mountain, GA
- Zip : 30083-3234
- Fax : (404) 297-8753
- Phone : (404) 296-3800
Second Address
- Dr. Edward Marvin Gotlieb
- 5405 Memorial Dr Building D
- Stone Mountain, GA
- Zip : 30083-3234
- Fax : (404) 297-8753
- Phone : (404) 296-3800
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2080A0000X | Adolescent Medicine | 014500 | GA |
National Provider Identifier
| NPI | 1093713356 |
|---|---|
| Provider Name | Dr. Edward Marvin Gotlieb |
| First Address | Stone Mountain, GA 30083-3234 |
| Second Address | Stone Mountain, GA 30083-3234 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 11/07/2005 |
| Last Update Date | 28/09/2011 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.