Provider Demographics
NPI:1518185321
Name:THOMAS W GOGGIN MD PC
Entity Type:Organization
Organization Name:THOMAS W GOGGIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-353-0711
Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2293
Mailing Address - Country:US
Mailing Address - Phone:706-353-0711
Mailing Address - Fax:
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE 602
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2293
Practice Address - Country:US
Practice Address - Phone:706-353-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29457207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6949Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER