Provider Demographics
NPI:1003853847
Name:GOLDENBERG, VIVIANA INES (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:INES
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:678-284-6282
Practice Address - Street 1:101 BANKS STA
Practice Address - Street 2:KAISER PERMANENTE FAYETTE MEDICAL CENTER
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7507
Practice Address - Country:US
Practice Address - Phone:678-610-3700
Practice Address - Fax:770-631-2415
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY39544207Q00000X
GA65552207Q00000X
GA065552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64124183Medicaid
GA003106664AMedicaid
OH2691912Medicaid
OH2691912Medicaid
KY0398436Medicare PIN
KY64124183Medicaid