Individual
MARK A GOTTLIEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3820 PLEASANT HILL RD STE 5, DULUTH, GA 30096-1429
(770) 476-9585
Mailing address
3820 PLEASANT HILL RD, SUITE 5, DULUTH, GA 30096-1429
(770) 476-9585
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
GA1238
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00451778G
—
GA
01
—
582238795
PROVIDER ID #
GA
Enumeration date
08/22/2006
Last updated
01/18/2019
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