Provider Demographics
NPI:1619927803
Name:GOY, JOHN M (MA,CCC-A)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:GOY
Suffix:
Gender:M
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 MADISON ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2208
Practice Address - Country:US
Practice Address - Phone:231-348-3666
Practice Address - Fax:231-348-6456
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN71660031Medicare PIN