Provider Demographics
NPI:1558571372
Name:TUTTLE, GORDON EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:EDWARD
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTURY PL NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-4307
Mailing Address - Country:US
Mailing Address - Phone:404-406-7259
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTURY PL NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-4307
Practice Address - Country:US
Practice Address - Phone:404-406-7259
Practice Address - Fax:404-321-1928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical