Healthcare Provider Details

I. General information

NPI: 1336201813
Provider Name (Legal Business Name): STUART MARTIN GOLDSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 OSLER CT
ALBANY GA
31707-0205
US

IV. Provider business mailing address

3525 PIEDMONT RD NE BLDG 7 SUITE 601
ATLANTA GA
30305-1578
US

V. Phone/Fax

Practice location:
  • Phone: 229-889-1827
  • Fax: 229-889-0305
Mailing address:
  • Phone: 229-889-1827
  • Fax: 229-889-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number035424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: