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General NPI Number Information
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NPI Number | 1598028060
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Entity Type | Individual
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Provider Name | SUSANNAH BURNS GOODMAN NP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 6070 LAKESIDE COMMONS DR
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City | MACON
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State | GA
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Zip | 31210-5778
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Country | US
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Telephone | 478-254-2644
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Fax | 478-254-4924
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Provider Business Mailing Address
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Address Line | 314 COCHRAN RD
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City | CONCORD
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State | GA
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Zip | 30206-2903
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Country | US
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Telephone | 404-664-7264
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN157565
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License Number State | GA
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