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General NPI Number Information
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NPI Number | 1215942875
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Entity Type | Organization
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Legal Business Name | KENNETH E. GOOLSBY, MD & ASSOCIATES, PC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 S ENOTA DR NE SUITE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501-3473
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Country | US
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Telephone | 770-534-8832
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Fax | 770-531-7479
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Provider Business Mailing Address
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Address Line | 200 S ENOTA DR NE SUITE 300
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City | GAINESVILLE
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State | GA
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Zip | 30501-3473
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Country | US
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Telephone | 770-534-8832
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Fax | 770-531-7479
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Authorized Official
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Title or Position | PRACTICE ADM.
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Name | STEPHANIE LACY
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Credential |
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Telephone | 770-534-8832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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