Provider Demographics
NPI:1093430654
Name:GOODMAN MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:GOODMAN MEDICAL SERVICES, PC
Other - Org Name:ACTIVATE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-268-4633
Mailing Address - Street 1:23 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5457
Mailing Address - Country:US
Mailing Address - Phone:912-230-2323
Mailing Address - Fax:
Practice Address - Street 1:5500 FREDERICA RD UNIT 2208
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-9703
Practice Address - Country:US
Practice Address - Phone:912-268-4633
Practice Address - Fax:888-771-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty