Provider Demographics
NPI:1023050143
Name:GOTTLIEB, STEVEN JEFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JEFFREY
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 ROBERTS DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4115
Mailing Address - Country:US
Mailing Address - Phone:709-528-6127
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:1272 VIRGIL LANGFORD RD
Practice Address - Street 2:STE 202
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:770-953-3331
Practice Address - Fax:678-744-0260
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0361207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003261026AMedicaid
SCTL0595Medicaid
SCE70189Medicare UPIN