Provider Demographics
NPI:1942498308
Name:ROBERT T GOETZINGER MD PC
Entity Type:Organization
Organization Name:ROBERT T GOETZINGER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:GOETZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-994-9913
Mailing Address - Street 1:131 UPPER RIVERDALE RD SW
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2540
Mailing Address - Country:US
Mailing Address - Phone:770-994-9913
Mailing Address - Fax:770-994-0706
Practice Address - Street 1:131 UPPER RIVERDALE RD SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2540
Practice Address - Country:US
Practice Address - Phone:770-994-9913
Practice Address - Fax:770-994-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018141207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29578Medicare UPIN