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General NPI Number Information
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NPI Number | 1275559452
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Entity Type | Organization
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Legal Business Name | ATLANTA HYPERBARIC & WOUND CARE CLINIC, L.L.C.
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2675 N DECATUR RD SUITE 312
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City | DECATUR
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State | GA
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Zip | 30033-6131
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Country | US
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Telephone | 404-501-7316
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Fax | 404-501-7319
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Provider Business Mailing Address
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Address Line | 2675 N DECATUR RD SUITE 312
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City | DECATUR
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State | GA
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Zip | 30033-6131
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Country | US
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Telephone | 404-501-7316
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Fax | 404-501-7319
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | GLENN L GOODHART
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Credential | M.D.
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Telephone | 404-501-7316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 044154
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License Number State | GA
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