Provider Demographics
NPI:1053658989
Name:HERBERT, JOHN GOSS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GOSS
Last Name:HERBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 PEACHTREE RD NE
Mailing Address - Street 2:LENOX TOWERS, SUITE 915
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1170
Mailing Address - Country:US
Mailing Address - Phone:404-261-1373
Mailing Address - Fax:
Practice Address - Street 1:3400 PEACHTREE RD NE
Practice Address - Street 2:LENOX TOWERS, SUITE 915
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1170
Practice Address - Country:US
Practice Address - Phone:404-261-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10566102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst