Provider Demographics
NPI:1275559452
Name:ATLANTA HYPERBARIC & WOUND CARE CLINIC, L.L.C.
Entity Type:Organization
Organization Name:ATLANTA HYPERBARIC & WOUND CARE CLINIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-501-7316
Mailing Address - Street 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6131
Mailing Address - Country:US
Mailing Address - Phone:404-501-7316
Mailing Address - Fax:404-501-7319
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE 312
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-501-7316
Practice Address - Fax:404-501-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA49-05588OtherUNITED FACILITY ID
GA00861682AMedicaid
GA51004393OtherSTATE HEALTH BENEFIT ID
GA51004393OtherBCBS FACILITY ID
GA00861682AMedicaid