Provider Demographics
NPI:1679863062
Name:GERSH, JONATHAN B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:GERSH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 CARTER AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-3246
Mailing Address - Country:US
Mailing Address - Phone:404-213-7151
Mailing Address - Fax:
Practice Address - Street 1:501 PULLIAM ST SW
Practice Address - Street 2:SUITE 407
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2755
Practice Address - Country:US
Practice Address - Phone:404-474-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical