Provider Demographics
NPI:1497787139
Name:GOLDBERG, SUSAN M (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4321 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3058
Mailing Address - Country:US
Mailing Address - Phone:706-854-2600
Mailing Address - Fax:706-854-2601
Practice Address - Street 1:4321 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3058
Practice Address - Country:US
Practice Address - Phone:706-854-2600
Practice Address - Fax:706-854-2601
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057465208M00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist