Provider Demographics
NPI:1356499685
Name:GOLDMAN, BRIAN HUNTER (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HUNTER
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 DAHLONEGA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2409
Mailing Address - Country:US
Mailing Address - Phone:678-485-6143
Mailing Address - Fax:
Practice Address - Street 1:347 DAHLONEGA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2409
Practice Address - Country:US
Practice Address - Phone:678-485-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002429103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist