NPIMap

Organization Active NPI

Jerald M. Gottlieb, PH.D, P.C.

  • Clinical Psychologist
  • Savannah, GA
National Provider Identifier
1275866527
Registry record updated Oct 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY002692 Issued in GA
Legal business name
JERALD M. GOTTLIEB, PH.D, P.C.
Practice address
7 Oglethorpe Professional Blvd Ste 3
Savannah, GA 31406-3677
Phone
(912) 224-5841
Fax
(912) 352-4220
NPI assigned
Sep 17, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2021

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

Authorized official

Name
Dr. Jerald M Gottlieb, PH.DNPI 1972548907
Title
Psychologist
Phone
(912) 224-5841

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PSY002692 GA Primary

Addresses

Primary practice location

7 Oglethorpe Professional Blvd Ste 3
Savannah, GA 31406-3677

Mailing address

7 Oglethorpe Professional Blvd Ste 3
Savannah, GA 31406-3677
Phone (912) 224-5841

Other identifiers 2

IdentifierTypeStateIssuer
663871593AMedicaidGA
1972548907OtherGANPI

National Provider Directory

National Provider Directory

Locations

450 Mall Blvd
Ste A2
Savannah, GA 31406
Phone (912) 354-8734

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1253145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1275866527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 OGLETHORPE PROFESSIONAL BLVD STE 3",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063677",
            "telephone_number": "912-224-5841",
            "fax_number": "912-352-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 OGLETHORPE PROFESSIONAL BLVD STE 3",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063677",
            "telephone_number": "912-224-5841",
            "fax_number": "912-352-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERALD M. GOTTLIEB, PH.D, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-17",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "GOTTLIEB",
        "authorized_official_first_name": "JERALD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "912-224-5841",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY002692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "663871593A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972548907",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; 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.