Provider Demographics
NPI:1790962827
Name:GUTMAN, DAVID ANDREW (MD PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GLENLAKE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1585
Mailing Address - Country:US
Mailing Address - Phone:404-966-3925
Mailing Address - Fax:
Practice Address - Street 1:200 GLENLAKE COMMONS DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1585
Practice Address - Country:US
Practice Address - Phone:404-966-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0016942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry