Healthcare Provider Details

I. General information

NPI: 1679757413
Provider Name (Legal Business Name): NORTH FULTON GENERAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 150
ROSWELL GA
30076-4976
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 150
ROSWELL GA
30076-4976
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-3117
  • Fax: 770-442-3718
Mailing address:
  • Phone: 770-442-3117
  • Fax: 770-442-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25166
License Number StateGA

VIII. Authorized Official

Name: DR. ALAN LEE GOLDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 770-442-3117