Provider Demographics
NPI:1952466641
Name:GOODRICH, MARILYN (DRSCHYG, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:DRSCHYG, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 POPLAR POINTE SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2213
Mailing Address - Country:US
Mailing Address - Phone:770-434-7916
Mailing Address - Fax:770-434-7916
Practice Address - Street 1:1864 INDEPENDENCE SQ STE A
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5160
Practice Address - Country:US
Practice Address - Phone:770-434-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical