Provider Demographics
NPI:1760597926
Name:GILSON, MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GILSON
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 1:62 LENOX POINTE NE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-7410
Mailing Address - Country:US
Mailing Address - Phone:404-842-0555
Mailing Address - Fax:404-842-0556
Practice Address - Street 1:62 LENOX POINTE NE STE B
Practice Address - Street 2:ATLANTA CENTER FOR COGNITIVE THERAPY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-7410
Practice Address - Country:US
Practice Address - Phone:404-842-0556
Practice Address - Fax:404-842-0556
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1022103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00305819BMedicaid
GAM62TCCGSMedicare ID - Type UnspecifiedPSYCHOLOGIST