Provider Demographics
NPI:1639392558
Name:GOODMAN, PATRICK GLENN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:GLENN
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7083
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7083
Mailing Address - Country:US
Mailing Address - Phone:229-391-2910
Mailing Address - Fax:229-238-0953
Practice Address - Street 1:39 KENT RD STE 8
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1697
Practice Address - Country:US
Practice Address - Phone:229-391-2910
Practice Address - Fax:229-386-4770
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA59158208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine