Healthcare Provider Details

I. General information

NPI: 1477536696
Provider Name (Legal Business Name): BARRY JAY GOLDSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 MEDICAL CENTER DR
AUGUSTA GA
30909-1810
US

IV. Provider business mailing address

1126 MEDICAL CENTER DR
AUGUSTA GA
30909-1810
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-5082
  • Fax: 706-863-4082
Mailing address:
  • Phone: 706-863-5082
  • Fax: 706-863-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20435
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: