Provider Demographics
NPI:1245361237
Name:GORE, PATRICIA E (PSYD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:E
Last Name:GORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 HIGHWAY 92 STE 120
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5235
Mailing Address - Country:US
Mailing Address - Phone:770-924-9700
Mailing Address - Fax:770-926-0690
Practice Address - Street 1:7450 HIGHWAY 92 STE 120
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5235
Practice Address - Country:US
Practice Address - Phone:770-924-9700
Practice Address - Fax:770-926-0690
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist