Provider Demographics
NPI:1801959267
Name:GOGGIN, THOMAS WESTBROOK (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WESTBROOK
Last Name:GOGGIN
Suffix:
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 1:700 SUNSET DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2293
Mailing Address - Country:US
Mailing Address - Phone:706-353-0711
Mailing Address - Fax:706-613-8454
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE 602
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2293
Practice Address - Country:US
Practice Address - Phone:706-353-0711
Practice Address - Fax:706-613-8454
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29457207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00352118BMedicaid
GAE16145Medicare UPIN
GA16BDBCWMedicare ID - Type UnspecifiedMEDICARE NUMBER