Provider Demographics
NPI:1750689485
Name:GOODEN, MALIKA B (DC, MPH, CMT)
Entity Type:Individual
Prefix:DR
First Name:MALIKA
Middle Name:B
Last Name:GOODEN
Suffix:
Gender:F
Credentials:DC, MPH, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 JOHNSON FERRY RD
Mailing Address - Street 2:BLDG B - SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4641
Mailing Address - Country:US
Mailing Address - Phone:770-693-2247
Mailing Address - Fax:770-693-2432
Practice Address - Street 1:2125 HILLTOP OVERLOOK WAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2915
Practice Address - Country:US
Practice Address - Phone:404-513-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor