Healthcare Provider Details

I. General information

NPI: 1023931516
Provider Name (Legal Business Name): SHAWN WELLS GOLDMAN OM, RM, WMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 JONESBORO RD STE D3
FOREST PARK GA
30297-1071
US

IV. Provider business mailing address

PO BOX 162299
ATLANTA GA
30321-2299
US

V. Phone/Fax

Practice location:
  • Phone: 678-783-4377
  • Fax:
Mailing address:
  • Phone: 404-991-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: