Provider Demographics
NPI:1326124330
Name:GOLDMAN, ALAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LEE
Last Name:GOLDMAN
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 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-442-3117
Mailing Address - Fax:678-701-1722
Practice Address - Street 1:2500 HOSPITAL BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4976
Practice Address - Country:US
Practice Address - Phone:770-442-3117
Practice Address - Fax:678-701-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO17806208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
493528OtherAETNA
GA000213705AMedicaid
493528OtherAETNA