Provider Demographics
NPI:1184864159
Name:GOLDHAGEN, HAVIVA
Entity Type:Individual
Prefix:
First Name:HAVIVA
Middle Name:
Last Name:GOLDHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4561 OLDE PERIMETER WAY APT 2002
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-6006
Mailing Address - Country:US
Mailing Address - Phone:404-403-0465
Mailing Address - Fax:
Practice Address - Street 1:4561 OLDE PERIMETER WAY APT 2002
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-6006
Practice Address - Country:US
Practice Address - Phone:404-403-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA211522083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine