Provider Demographics
NPI:1568229904
Name:MARRA E ROSA, GABRIEL ARTUR (PHD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ARTUR
Last Name:MARRA E ROSA
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 1:2320 PERIMETER PARK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1317
Mailing Address - Country:US
Mailing Address - Phone:404-373-8335
Mailing Address - Fax:
Practice Address - Street 1:2320 PERIMETER PARK DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1317
Practice Address - Country:US
Practice Address - Phone:404-373-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4707103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist