Provider Demographics
NPI:1306824305
Name:GOODJOIN, RICHARD BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BERNARD
Last Name:GOODJOIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 CARNEGIE PL
Practice Address - Street 2:SUITE 103
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3980
Practice Address - Country:US
Practice Address - Phone:770-716-7999
Practice Address - Fax:770-716-8444
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF63364Medicare UPIN
GA11SCFXFMedicare ID - Type Unspecified