Healthcare Provider Details

I. General information

NPI: 1437365616
Provider Name (Legal Business Name): PAUL AARON GOLDBERG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 WINDY HILL RD SE SUITE 203
MARIETTA GA
30067-8644
US

IV. Provider business mailing address

3672 MEMORIAL PKWY NW
KENNESAW GA
30152-2438
US

V. Phone/Fax

Practice location:
  • Phone: 770-974-7470
  • Fax:
Mailing address:
  • Phone: 770-974-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: