Provider Demographics
NPI:1346312253
Name:JOHN A GOLDMAN MD PC
Entity Type:Organization
Organization Name:JOHN A GOLDMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-252-0230
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 293
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-252-0230
Mailing Address - Fax:404-252-7574
Practice Address - Street 1:5555 PEACHTREE DUNWOODY ROAD
Practice Address - Street 2:SUITE 293
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-0230
Practice Address - Fax:404-252-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15256207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00057439CMedicaid
GA66BB8HHMedicare ID - Type Unspecified
GA00057439CMedicaid