Provider Demographics
NPI:1407075880
Name:GOODMAN, MARCUS BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:BRIAN
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2500 HOSPITAL BLVD STE 280
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4918
Mailing Address - Country:US
Mailing Address - Phone:770-754-0787
Mailing Address - Fax:770-755-5890
Practice Address - Street 1:2500 HOSPITAL BLVD STE 280
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4918
Practice Address - Country:US
Practice Address - Phone:770-754-0787
Practice Address - Fax:770-755-5890
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA064221207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I071875Medicare PIN