Provider Demographics
NPI:1194839597
Name:GOYCO, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GOYCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 HONEY CREEK PKWY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2974
Mailing Address - Country:US
Mailing Address - Phone:770-929-0813
Mailing Address - Fax:770-929-3868
Practice Address - Street 1:2020 HONEY CREEK PKWY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2974
Practice Address - Country:US
Practice Address - Phone:770-929-0813
Practice Address - Fax:770-929-3868
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000834424AMedicaid
080145770OtherMEDICARE RAILROAD
080145770OtherMEDICARE RAILROAD
GA08BDQBCMedicare ID - Type Unspecified