MEDICARE: DR. ROBERTA GOLDEN PH.D.

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
1	103T00000X	Psychologist	GA#428	GA

General Provider Information

NPI Number	:	1538301239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA GOLDEN PH.D.

Provider Business Mailing Address
First Line	:	3423 PIEDMONT ROAD, N.E.
Second Line	:	SUITE 514
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	404-237-9090
Fax Number	:	404-351-0004

Provider Business Practice Location Address
First Line	:	3423 PIEDMONT ROAD
Second Line	:	SUITE 514
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	404-237-9090
Fax Number	:	404-351-0004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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