Provider Demographics
NPI:1396774592
Name:BRENNAN, GOODMAN FREDERICK (PHD)
Entity type:Individual
Prefix:DR
First Name:GOODMAN
Middle Name:FREDERICK
Last Name:BRENNAN
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 1:275 NORTHMILL PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4859
Mailing Address - Country:US
Mailing Address - Phone:770-957-0009
Mailing Address - Fax:678-583-4978
Practice Address - Street 1:1601 S ZACK HINTON PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6817
Practice Address - Country:US
Practice Address - Phone:678-583-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical