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NPI Code Detail

MEDICARE: GAINNEOS R. GOLDIE MD

MEDICARE: GAINNEOS R. GOLDIE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianM0735TX
2207RG0300XGeriatric Medicine (Internal Medicine) Physician87599GA
3207RG0300XGeriatric Medicine (Internal Medicine) PhysicianMD447980PA
4207R00000XInternal Medicine Physician87599GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18W8852OTHERTXBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194778878
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAINNEOS R. GOLDIE MD
Provider Business Mailing Address
First Line : 3020 HIGHWAY 124
Second Line :
City : SNELLVILLE
State : GA
Zip : 30039-4614
Country : US
Telephone Number : 770-978-1331
Fax Number : 770-978-8580
Provider Business Practice Location Address
First Line : 3020 HIGHWAY 124
Second Line :
City : SNELLVILLE
State : GA
Zip : 30039-4614
Country : US
Telephone Number : 770-978-1331
Fax Number : 770-978-8580
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 04/13/2023

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1538156542 — BENJAMIN ABRAHAM DO
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1134155153 — MICHAEL AUSTIN M.D.
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1447358254 — DAVID NEIL BRONAUGH P.A.C.
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1710185178 — MRS. DIANNE THORNLEY SHEINTAL PA-C
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Practice Fax: 770-978-8580

Directions to “ GAINNEOS R. GOLDIE MD” Practice Location

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