Individual
DR. GERSHOM THEOPHILUS LAZARUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
36 EAGLE ROW, ATLANTA, GA 30322-0001
(910) 616-9657
Mailing address
1215 LAVISTA RD NE, ATLANTA, GA 30324-3739
(910) 616-9657
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY004440
GA
103T00000X
Psychologist
Primary
PSY004440
GA
Other
Enumeration date
01/29/2021
Last updated
01/29/2021
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