Provider Demographics
NPI:1114997608
Name:GOODMAN, GERRI BETH (PH D)
Entity Type:Individual
Prefix:
First Name:GERRI
Middle Name:BETH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BUFORD HWY NE
Mailing Address - Street 2:DRUID POINTE SUITE 401
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3207
Mailing Address - Country:US
Mailing Address - Phone:404-639-5556
Mailing Address - Fax:404-639-5558
Practice Address - Street 1:2751 BUFORD HWY NE
Practice Address - Street 2:DRUID POINTE SUITE 401
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3207
Practice Address - Country:US
Practice Address - Phone:404-639-5556
Practice Address - Fax:404-639-5558
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002506103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q52834Medicare UPIN
68BBGPZMedicare ID - Type Unspecified