Provider Demographics
NPI:1003079203
Name:GOODMAN, ROBERT H (NMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:H
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAFAYETTE DR NE APT 4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3344
Mailing Address - Country:US
Mailing Address - Phone:404-932-0323
Mailing Address - Fax:678-904-5612
Practice Address - Street 1:124 LAFAYETTE DR NE APT 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3344
Practice Address - Country:US
Practice Address - Phone:404-932-0323
Practice Address - Fax:678-904-5612
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002271174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist