Provider Demographics
NPI:1033394820
Name:MARK GILSON PHD PC
Entity Type:Organization
Organization Name:MARK GILSON PHD PC
Other - Org Name:ATLANTA CENTER FOR COGNITIVE THERAPY, MARK GILSON, PH.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-248-1159
Mailing Address - Street 1:1772 CENTURY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3396
Mailing Address - Country:US
Mailing Address - Phone:404-248-1159
Mailing Address - Fax:404-248-9776
Practice Address - Street 1:1772 CENTURY BOULEVARD, NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3396
Practice Address - Country:US
Practice Address - Phone:404-248-1159
Practice Address - Fax:404-248-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1022103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00305819BMedicaid
GAP87440Medicare UPIN
GA00305819BMedicaid