Edward Marvin Gotlieb, MD

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

014500 Issued in GA

Practice address

5405 Memorial Dr
Building D
Stone Mountain, GA 30083-3234

Phone

(404) 296-3800

Fax

(404) 297-8753

NPI assigned

Jul 11, 2005

Last updated

Sep 28, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: edward.gotlieb@gadirect.net
• Direct secure messaging: edward.gotlieb@tpc.gadirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edward M. Gotlieb, M.D., Et Al Dba the Pediatric Center

  dba The Pediatric Center

  • Pediatrics Physician
  • Stone Mountain, GA
  • NPI 1619197498
  NPD
• The Pediatric Center of Stone Mountain

  • Pediatrics Physician
  • Stone Mountain, GA
  • NPI 1699139675
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317168000000",
    "number": "1093713356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5405 MEMORIAL DR",
            "address_2": "BUILDING D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833234",
            "telephone_number": "404-296-3800",
            "fax_number": "404-297-8753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 MEMORIAL DR",
            "address_2": "BUILDING D",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833234",
            "telephone_number": "404-296-3800",
            "fax_number": "404-297-8753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTLIEB",
        "first_name": "EDWARD",
        "middle_name": "MARVIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2011-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "GA",
            "license": "014500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cierra Goodwin
• Rondine O Gordon, RN
• Mulembet Gorfu, RN
• Fred Dexter Gose, MD
• Sandeep D Goswami, NP
• Jaquelin Smith Gotlieb, MD
• Grace Medical Institute
• Jarred Augustus Graham, DDS
• Grant Services for the Disabled , Inc.
• Monique F Gray, PH.D.

• Pediatric Adolescent Medicine Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Pediatric Adolescent Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.