Provider Demographics
NPI:1407816432
Name:GOODMAN, BRAD HENRY (M D)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:HENRY
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2668
Mailing Address - Country:US
Mailing Address - Phone:912-354-6190
Mailing Address - Fax:912-354-6172
Practice Address - Street 1:505 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2668
Practice Address - Country:US
Practice Address - Phone:912-354-6190
Practice Address - Fax:912-354-6172
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38780207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG38780Medicaid
GA000762022EMedicaid
030004120OtherRAILROAD MEDICARE
768017OtherBLUE CROSS BLUE SHIELD