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General NPI Number Information
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NPI Number | 1174795298
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Entity Type | Organization
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Legal Business Name | BRIAN H. GOLDMAN, PH.D., PC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 347 DAHLONEGA ST SUITE 103
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City | CUMMING
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State | GA
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Zip | 30040-2406
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Country | US
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Telephone | 678-495-6143
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Fax | 678-455-9496
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Provider Business Mailing Address
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Address Line | 347 DAHLONEGA ST SUITE 103
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City | CUMMING
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State | GA
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Zip | 30040-2406
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Country | US
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Telephone | 678-495-6143
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Fax | 678-455-9496
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN HUNTER GOLDMAN
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Credential | PH.D.
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Telephone | 678-485-6143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY002429
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License Number State | GA
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