Provider Demographics
NPI:1740427947
Name:GOOD, PHILIP RICHARD (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:RICHARD
Last Name:GOOD
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 BEAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9765
Mailing Address - Country:US
Mailing Address - Phone:301-775-8233
Mailing Address - Fax:
Practice Address - Street 1:5015 N 34TH ST
Practice Address - Street 2:BLDG 900
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-5245
Practice Address - Country:US
Practice Address - Phone:404-469-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01786133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered