Provider Demographics
NPI:1407467996
Name:GOODMAN, MARY ASHLEY (DC)
Entity Type:Individual
Prefix:
First Name:MARY ASHLEY
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 HABERSHAM VLY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1491
Mailing Address - Country:US
Mailing Address - Phone:404-456-8122
Mailing Address - Fax:
Practice Address - Street 1:9570 NESBIT FERRY RD STE 101
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6859
Practice Address - Country:US
Practice Address - Phone:404-456-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010369111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner