Healthcare Provider Details

I. General information

NPI: 1184864159
Provider Name (Legal Business Name): HAVIVA GOLDHAGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4561 OLDE PERIMETER WAY APT 2002
ATLANTA GA
30346-6006
US

IV. Provider business mailing address

4561 OLDE PERIMETER WAY APT 2002
ATLANTA GA
30346-6006
US

V. Phone/Fax

Practice location:
  • Phone: 404-403-0465
  • Fax:
Mailing address:
  • Phone: 404-403-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number21152
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: