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General NPI Number Information
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NPI Number | 1447348826
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Entity Type | Individual
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Provider Name | BRADLEY GORDON GOLDBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2010 OCILLA RD
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City | DOUGLAS
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State | GA
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Zip | 31533-2230
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Country | US
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Telephone | 912-384-2500
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Fax | 912-383-6788
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Provider Business Mailing Address
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Address Line | 11 CROSS ST
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City | HAZLEHURST
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State | GA
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Zip | 31539
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Country | US
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Telephone | 912-384-2500
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Fax | 912-383-6788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 040079
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License Number State | GA
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