Provider Demographics
NPI:1720072499
Name:ESPY, GOODMAN BASIL III (MD)
Entity Type:Individual
Prefix:DR
First Name:GOODMAN
Middle Name:BASIL
Last Name:ESPY
Suffix:III
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 1:699 CHURCH ST. NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1122
Mailing Address - Country:US
Mailing Address - Phone:770-422-8700
Mailing Address - Fax:770-425-7601
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1122
Practice Address - Country:US
Practice Address - Phone:770-422-8700
Practice Address - Fax:770-425-7601
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39795AMedicaid
GAD39812Medicare UPIN
GA111544050AMedicare ID - Type Unspecified
GA39795AMedicaid