Healthcare Provider Details

I. General information

NPI: 1952411399
Provider Name (Legal Business Name): DONALD S. GOGGANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESEARCH DR
ATHENS GA
30605-2738
US

IV. Provider business mailing address

220 RESEARCH DR
ATHENS GA
30605-2738
US

V. Phone/Fax

Practice location:
  • Phone: 706-583-2870
  • Fax: 706-369-5877
Mailing address:
  • Phone: 706-583-2870
  • Fax: 706-369-5877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number49570
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: