Provider Demographics
NPI:1881744472
Name:GAY, MILTON STEPHEN (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:STEPHEN
Last Name:GAY
Suffix:
Gender:M
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 KARLS GATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-1630
Mailing Address - Country:US
Mailing Address - Phone:770-650-3901
Mailing Address - Fax:770-650-3906
Practice Address - Street 1:4840 ROSWELL RD NE
Practice Address - Street 2:BUILDING D, SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2639
Practice Address - Country:US
Practice Address - Phone:770-650-3901
Practice Address - Fax:770-650-3906
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0001511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I809585Medicare PIN
GA80BBCKHMedicare ID - Type Unspecified
GAR13055Medicare UPIN