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General NPI Number Information
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NPI Number | 1104831064
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Entity Type | Organization
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Legal Business Name | NEIL E GOODMAN MD PC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2500 STARLING ST SUITE # 401
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City | BRUNSWICK
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State | GA
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Zip | 31520-4219
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Country | US
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Telephone | 912-554-0544
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Fax | 912-554-0344
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Provider Business Mailing Address
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Address Line | 2500 STARLING ST SUITE # 401
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City | BRUNSWICK
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State | GA
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Zip | 31520-4219
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Country | US
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Telephone | 912-554-0544
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Fax | 912-554-0344
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | NEIL EVAN GOODMAN
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Credential | M.D.
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Telephone | 912-554-0544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 034143
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 034143
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License Number State | GA
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