Healthcare Provider Details

I. General information

NPI: 1144313826
Provider Name (Legal Business Name): STEPHEN M. GOODEN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 B HARPER STREET
AUGUSTA GA
30901
US

IV. Provider business mailing address

1430 B HARPER STREET
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-5451
  • Fax: 706-724-9562
Mailing address:
  • Phone: 706-724-5451
  • Fax: 706-724-9562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number033972
License Number StateGA

VIII. Authorized Official

Name: STEPHEN M GOODEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 706-724-5451