Provider Demographics
NPI:1053460659
Name:GOTHARD, ANDREW M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:GOTHARD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2308 PERIMETER PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1316
Mailing Address - Country:US
Mailing Address - Phone:770-457-5577
Mailing Address - Fax:770-457-5599
Practice Address - Street 1:2308 PERIMETER PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1316
Practice Address - Country:US
Practice Address - Phone:770-457-5577
Practice Address - Fax:770-457-5599
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY002146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical