Provider Demographics
NPI:1467449165
Name:GOODMAN, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1336 HIGHWAY 54 W
Mailing Address - Street 2:BUILDING 500
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4549
Mailing Address - Country:US
Mailing Address - Phone:770-461-1238
Mailing Address - Fax:770-460-6610
Practice Address - Street 1:1336 HIGHWAY 54 W
Practice Address - Street 2:BUILDING 500
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4549
Practice Address - Country:US
Practice Address - Phone:770-461-1238
Practice Address - Fax:770-460-6610
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040080207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000662208CMedicaid
GA000662208EMedicaid
GA000662208EMedicaid
GA20BBDWFMedicare PIN