Provider Demographics
NPI:1336201813
Name:GOLDSMITH, STUART MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:MARTIN
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 PIEDMONT RD NE
Mailing Address - Street 2:BLDG 7 SUITE 601
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1578
Mailing Address - Country:US
Mailing Address - Phone:229-889-1827
Mailing Address - Fax:229-889-0305
Practice Address - Street 1:2401 OSLER CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0205
Practice Address - Country:US
Practice Address - Phone:229-889-1827
Practice Address - Fax:229-889-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035424207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00525577AMedicaid
GA341192OtherWELLCARE
GAC76682Medicare UPIN
GA00525577AMedicaid